Impact of a Pharmacist-managed Outpatient Deep Vein Thrombosis Clinic on Length of Stay and Hospital Admissions

Julia Nickerson-Troy, M.S., Pharm.D., Kristin Morse, Pharm.D., Arti Bhavsar, Pharm.D., Rebecca Prevost, Pharm.D.

Florida Hospital-Celebration Health
Celebration, Florida

Purpose

This innovative project was designed to extend the services of an already established pharmacist-managed outpatient anticoagulation clinic at a 100-bed, community-based hospital to include the management of patients with uncomplicated deep vein thrombosis (DVT). The objectives of this study were to decrease the number of in-patient DVT admissions, reduce length of stay (LOS) associated with DVT admissions, streamline management of DVT patients, and export a successful model to six other sister campuses.

Description of the Program

A primary care residency-trained pharmacist was hired to develop the clinic's policies and procedures, determine the eligibility criteria for enrollment and launch the DVT program. Initially, the DVT pharmacist offered continuing education programs to all healthcare practitioners, including physicians, pharmacists, nurses, case managers, and support staff. These sessions discussed the epidemiology of DVTs, treatment options, and the role of the outpatient DVT Clinic, including procedures for identifying patients and methods for enrolling patients. In order to assure that the DVT Clinic was notified of all positive DVT patients, the DVT pharmacist worked closely with the Echo Technologists. Following enrollment into the clinic, patients were telephoned daily to document compliance with therapy and status of symptoms and/or side effects. Patients returned to the clinic for management of international normalized ratios utilizing a point-of-care testing device. Working under a collaborative practice agreement, adjustments in therapy were made by the pharmacist, and a follow up report of the visit was faxed to the physician. Once the pilot hospital's DVT program was successfully running, the model was exported to a sister campus to replicate.

Experience with the Program

The pilot hospital's DVT Clinic was responsible for preventing 10 inpatient admissions and for shortening LOS by 23% to 2.7 days within six months of opening. In addition, over the last 16 months, 48 patients have been enrolled in the DVT Clinic, resulting in 416 outpatient visits. No patients have been readmitted for DVT complications while enrolled in the DVT Clinic and none of the patients have reported adverse events.

Conclusion

Extension of the already established pharmacist-managed outpatient anticoagulation service to include uncomplicated DVTs resulted in avoided hospital admissions and in reduced length of stays without patient complications. This indicates that a pharmacist-managed outpatient DVT service can provide for safe, effective and improved patient care.

View a pdf of the poster from the Midyear Meeting (3.7mb).