VARIATION IN THE MANAGEMENT OF DEEP-VEIN THROMBOSIS - IMPLICATIONS FOR THE POTENTIAL IMPACT OF A CRITICAL PATHWAY

PURPOSE: TO evaluate the potential impact of a practice guideline in t he form of a critical pathway on variation and quality of care in pati ents with deep vein thrombosis (DVT). METHODS: Goals were identified f or key steps and processes that were believed to be important for meet ing a length-of-stay (LOS) goal of 5.5 days, and for improving quality of care for patients with DVT. Data collected via chart review were u sed to determine the percentage of patients with uncomplicated DVT adm itted in the year after October 1, 1992, whose management would have m et these goals. RESULTS: Only 11 (12%) of 92 eligible patients with a primary discharge diagnosis of DVT met the LOS goal. In 30%, the activ ated partial thromboplastin time (aPTT) was > 60 seconds within a targ et of 12 hours after admission. The goals for the initiation of warfar in (within 12 hours after aPTT > 60 seconds) and the achievement of a therapeutic international normalized ratio (INR) level (within 120 hou rs) were met in 51% and 58% of patients, respectively. The target dura tion of intravenous heparin therapy was achieved in 78% of patients. O nly 18% of patients, however, were discharged within 12 hours after 96 hours of heparin therapy had been given and a therapeutic INR had bee n achieved. CONCLUSIONS: These data demonstrate considerable variation in management of uncomplicated DVT at a single hospital, suggesting t hat a critical pathway could have impact on both LOS and quality of ca re.