Implementing Screening for Venous Thromboembolism in an Urgent Care Setting: A Quality Improvement Pilot Project

Background: Venous thromboembolism (VTE), which includes both deep vein thrombosis and pulmonary embolism, may have serious health consequences for patients. However, over-referral of patients with these suspected symptoms may also result in burden to emergency departments and health care systems. Evidence-based screening tools are available to aid clinicians in determining which patients are at risk and need further evaluation and in which patients VTE can safely be excluded. Current literature suggest that outpatient settings are not adequately screening for VTE events. In the clinical implementation site, there is no care process for using VTE screening. These screening tools are not readily accessible to urgent care clinicians which pose a significant barrier to patient care. Methods: The quality improvement project took place in two University of Utah urgent care clinics. The Wells' Criteria for DVT and the Primary Rule with the Pulmonary Embolism Rule Out Criteria and the Geneva Rule were used as screening tools for DVT and PE respectively. These tools were integrated into the electronic medical record (EMR). Education on their use was provided to nursing and provider staff. Using key search terms pre and post intervention chart review was conducted. Results were analyzed using Fisher's exact test. Key findings: Over-referral to the emergency department without prior screening was present in the urgent care setting. Development of a care process model and integration of screening tools into the EMR significantly improved VTE screening during the study period. Conclusion: This study demonstrates that a clear care process model and having VTE screening tools available in the EMR can increase the number of patients screened. More research is needed to evaluate whether screening decreases over-referral to the ED and reduces costs for patients and insurers.