Abstract
Venous duplex evaluation (VDE) has virtually supplanted venography in the diagnosis
of deep vein thrombosis (DVT). To control low yield of VDE of ambulatory patients,
performed at “off-hours,” we adopted an algorithm to improve the selection process
and to increase efficiency. “Off-hours” studies are those performed after the normal
daily working hours, weekends, or holidays. From January 1, 1996, through December
31, 1998, we performed 5393 lower extremities VDE, utilizing color duplex imaging
with video taping. 2535 studies were done during the eighteen months prior to adoption
of the algorithm on July 1, 1997 and 2858 studies were performed during the subsequent
eighteen months. During the first 18 months, 314 requests for emergency studies came
from the Emergency Department (ED). 132 were “off-hours” and 24 (18.2%) were positive
for DVT compared to 427 after adoption of the algorithm, of which 79 were “off-hours”
with 24 being positive for DVT (30.3%). Using an algorithm for dealing with requests
for VDE originating in the ED on outpatients at “off-hours” resulted in an overall
decrease in requests as well as a greater yield of positive studies without apparent
compromise of the quality of care.
