ABSTRACT
This is a retrospective cohort study of adults with a primary diagnosis of deep venous thrombosis (DVT) unaccompanied by pulmonary embolism (PE), seen in 4 emergency departments in 2013 and part of 2014. The purpose was to assess the prevalence of home treatment of DVT in the present era of new oral anticoagulants. Among 96 patients with DVT and no PE, 85 (88.5%) were hospitalized and 11 (11.5%) were discharged to home. Most of the patients discharged to home received low-molecular-weight heparin, 9 (81.8%) of 11. None were prescribed new oral anticoagulants. Early discharge in ≤2 days occurred 28 (32.9%) of 85 patients. Most (64.3%) received enoxaparin and/or warfarin at early discharge. Rivaroxaban was prescribed in 7 (25.0%) of those discharged in ≤2 days. We conclude that in some emergency departments, patients with DVT are uncommonly discharged to home even though new oral anticoagulants are available.
Subject(s)
Anticoagulants/administration & dosage , Enoxaparin/administration & dosage , Rivaroxaban/administration & dosage , Venous Thrombosis/drug therapy , Warfarin/administration & dosage , Administration, Oral , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
OBJECTIVES: We developed a communication instrument to be used in the Emergency Department (ED) and hypothesized that use of this guide would increase patient comprehension of and satisfaction with care. METHODS: This multi-site trial enrolled 643 patients in treatment and control groups. Comprehension of care was assessed by chart review and satisfaction measured via validated survey. RESULTS: Use of the instrument was not associated with improvements in patient knowledge about their care, with a mean of 4.6 (95% CI: 4.8-5.8) comprehension defects in the control group and 4.4 (95% CI: 3.9-4.9) in the treatment group. There was no significant effect on patient satisfaction 76.4% versus 76.9%, p=0.34. Elderly patients in both groups were found to have 1.1 (p<0.01) more knowledge gaps than younger patients. CONCLUSION: Patients frequently misunderstand medical care in the ED. Comprehension decreases with increasing age. An isolated communication instrument does not improve satisfaction with or understanding of the care received. PRACTICE IMPLICATIONS: Providing a structured place for providers and patients to record details of care does not seem to improve satisfaction with or comprehension of care. Interventions that focus on communication skills and face time with patients may prove more effective.
