A&E/EDTU Improving Care for Patients with Lower Limb Deep Vein Thrombosis (DVT)
Care Process & Redesign
Yishun Health One Improvement Festival
National Healthcare Group
8 April 2025
The aims of this protocol are to enable patients to undergo ultrasound of their lower limb to confirm the diagnosis within. In the post-protocol cohort, while 8 patients had re-presented to A&E within a month of their discharge from EDTU, none of these.
Year Submitted: 2025
Published Date: 08 April 2025
Tags: Care Process ＆ Redesign, Quality Improvement, Workflow Redesign, Cost Saving, Time Saving, Productivity, Access To Care, Waiting Time, Bed Occupancy Rate, Value Based Care, Length Of Stay
About this Content
Aims
The aims of this protocol are to enable patients to undergo ultrasound of their lower limb to confirm the diagnosis within 24 hours, effectively commencing their treatment earlier and reducing ward admission and/or inpatient length of stay.
Background
Prior to commencing this EDTU DVT protocol, A&E patients suspected of having lower limb DVT were admitted to the wards to undergo ultrasound of their lower limb to confirm the diagnosis. Patients would typically wait 2-3 days for an ultrasound to be carried out. Anti-coagulation treatment may only be started once the diagnosis of DVT is confirmed.
Methods
The new EDTU DVT pathway starting January 2022 allows patients to undergo ultrasound within 24 hours. Inclusion criteria include being haemodynamically stable, having an isolated lower limb DVT, no signs or symptoms suggesting pulmonary embolism, ability to ambulate, and agreement for outpatient care after management in EDTU. Exclusion criteria include age 75 years, significant renal impairment, weight 120kg, concomitant cancer, pregnancy, proximal femoral DVT, active bleeding, existing anti-coagulation treatment, multiple co-morbidities, and poor social support.
Results
Ward admission rates of A&E patients suspected of having lower limb DVT reduced by 50%, and inpatient length of stay reduced by 50%. There was an 86% reduction in patients admitted to the ward and an 83% reduction in average length of stay. Faster diagnosis and starting of treatment improved patient quality of care and safety.
Conclusion
In the post-protocol cohort, while 8 patients had re-presented to A&E within a month of their discharge from EDTU, none of these patients were diagnosed with a complication related to the DVT. The protocol led to significant bed day cost savings and improved patient care.
Lessons Learnt
Regular audits were carried out for compliance and improvement. Regular staff training ensured quality of care and safety of patients. Regular feedback and review with staff ensured smooth process flow.
Additional Information
Based on January 2022 to September 2024 data, the protocol resulted in $1,303,340 bed day cost savings and 651.67 bed day savings.
Keywords
DVT, Ultrasound, Anti-Coagulation, Patient Care, Protocol
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Khoo Teck Puat Hospital |
Platform(s) | Yishun Health One Improvement Festival |
Healthcare Professional Group(s) | Medical |
Applicable Specialty or Discipline | Emergency Medicine, Podiatry |
Project Lead(s) | Th’ng F, Swarup S |
Project Member(s) | Rachel Yek |
Connect with this contributor!
KTPH & YCH Innovation & Improvement (I&I) Office - i-i@ktph.com.sg
Project Attachment
754_KTPH_OIF 2025_EDTU Improving Care for Patients with Lower Lim.pdf