Lowering DVT-Related ED Visits via a Primary Care POCUS Pathway

Area of Science:

• Primary Care Medicine
• Diagnostic Imaging
• Quality Improvement Science

Background:

• Prompt diagnosis of lower extremity deep vein thrombosis (DVT) is crucial to prevent pulmonary embolism (PE).
• Point-of-care ultrasound (POCUS) is effective for DVT diagnosis in emergency departments (EDs), but its impact in primary care is less studied.
• This quality improvement (QI) project aimed to implement and evaluate a primary care DVT POCUS pathway to decrease reliance on ED visits.

Purpose of the Study:

• To establish and assess the feasibility and acceptability of a DVT POCUS pathway within a primary care setting.
• To evaluate the potential impact of this pathway on reducing emergency department utilization.
• To explore the cost-effectiveness of integrating DVT POCUS into primary care.

Main Methods:

• A POCUS fellowship-trained physician performed DVT evaluations and management for referred primary care patients over 14 months.
• Data collection included patient outcomes via chart review and clinician feedback through surveys.
• The study assessed the pathway's feasibility, acceptability, and potential to reduce ED visits.

Main Results:

• Eighty patients were evaluated, with 5% (4/80) testing positive for DVT.
• The pathway potentially averted 46% (37/80) of ED visits, estimating $85,100 in cost savings.
• Referring clinicians reported high satisfaction, with 98% agreeing the pathway improved safety, access, and reduced cognitive burden and ED referrals.

Conclusions:

• A primary care DVT POCUS pathway is a feasible and acceptable model for managing suspected DVTs.
• This integrated approach shows potential for cost savings and improved patient care by reducing ED visits.
• Further research is recommended to validate this model for broader implementation in primary care settings.