Since 2015, our urgent care system has utilized an outpatient evaluation of patients with suspected lower extremity DVT (Deep Vein Thrombosis) using Doppler ultrasound, 7 days per week in collaboration with local vein centers. This report describes 580 patients who were evaluated over 54 months after consultation by urgent care providers and vascular specialists. During these visits, decisions to anti-coagulate before the visit occurred in 6% of the patients, with a significant savings in time and cost for the patient. A standard ED/ER visit in our market often exceeds $3000, including associated ED physician charges and imaging with radiology interpretation, compared to the $175 charge for outpatient lower extremity Doppler study with interpretation. No patient suffered a complication or progression of DVT, or complication from the use of systemic anticoagulants. Subsequently, our urgent care system has standardized this process in all centers seeing patients with suspected DVTs.
Coordinate with an area vein center to directly refer patients with a suspected DVT (without evidence or concerns for a PE)
Analyze whether offering such referrals to a vein center is cost-effective and in the best interest of the patient
Implement a program where patients can be appropriately referred directly to an area vein center instead of an ED
Document that urgent care visit to reflect an appropiate evaluation for a DVT (including consultation with an area vein center), ruling-out a clinical likelihood for a PE
Implement a system that incorporates integrating feedback from an area vein center into a patient’s medical record, ensuring appropriate management for either the vein center or the primary care physician, with feedback to the referring urgent care provider.