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International Journal for Quality in Health Care Advance Access originally published online on May 4, 2005
International Journal for Quality in Health Care 2005 17(5):433-438; doi:10.1093/intqhc/mzi050
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International Journal for Quality in Health Care vol. 17 no. 5 © The Author 2005. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved

Quality in Practice

Management of suspected venous thromboembolism: the impact of a multifaceted intervention

Pierre-Yves Salaun, Francis Couturaud, Karine Lacut, Michel Nonent, Christophe Gut-Gobert, Gregoire Le Gal, Philippe Guillo, Jean Jouquan, Dominique Mottier and Christophe Leroyer

Groupe d’Etude de la Thrombose de Bretagne Occidentale (GETBO), Hôpital de la Cavale Blanche, 29609 Brest Cedex, France

Objective. To achieve a common strategy in the event of a suspected venous thromboembolism.

Design. A multifaceted intervention, combining an audit strategy and implementation of local guidelines: phase 1, the first step, consisted of a 6-month audit to identify dysfunction; during phase 2, intervention, local guidelines were formulated by a working group and then implemented; phase 3 consisted of a re-audit over a 6-month period following the intervention.

Setting. A tertiary hospital, France.

Participants. 419 patients with suspected venous thromboembolism in phase 1; 287 patients with suspected pulmonary embolism in phase 3.

Results. First phase: a dysfunction was observed in three of five criteria under study: (i) the diagnostic procedure lasted more than 48 hours in 114 patients (27.2%); (ii) no anticoagulant therapy at the time of suspicion in 116 patients (27.7%); (iii) an inconclusive lung scan without further testing in the event of a suspected pulmonary embolism in 40 patients (14%); the intervention phase was thus restricted to the management of suspected pulmonary embolism; similar results were found during the phase 3 re-audit.

Conclusion. No improvement in the diagnostic work-up in the event of a suspected pulmonary embolism was observed following this multifaceted intervention.

Keywords: audit, deep vein thrombosis, multifaceted intervention, pulmonary embolism

Address reprint requests to Christophe Leroyer, Department of Internal Medicine and Chest Diseases, Hôpital de la Cavale Blanche, F-29609 Brest Cedex, France. E-mail: christophe.leroyer{at}chu-brest.fr

Accepted for publication March 22, 2005.


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