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International Journal for Quality in Health Care Advance Access published online on May 4, 2005
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzi050
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International Journal for Quality in Health Care © The Author 2005. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved
Accepted March 22, 2005

Article

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

Pierre-Yves Salaun 1, Francis Couturaud 1, Karine Lacut 1, Michel Nonent 1, Christophe Gut-Gobert 1, Gregoire Le Gal 1, Philippe Guillo 1, Jean Jouquan 1, Dominique Mottier 1, and Christophe Leroyer 1*

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

* To whom correspondence should be addressed.
Christophe Leroyer, E-mail: christophe.leroyer{at}chu-brest.fr


  Abstract

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.
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