Outpatient deep vein thrombosis treatment models.

Approximately 9000 patients are admitted annually to Canadian hospitals with a primary diagnosis of deep vein thrombosis (DVT). Although this is a serious medical condition, potentially more than 40% of all patients with uncomplicated DVT, or 3600 Canadian patients/year, may be safely treated as outpatients with low-molecular-weight heparin. Outpatient treatment avoids costly hospitalization that is required for the standard 5-10 days of intravenous unfractionated heparin therapy. Although institutions vary widely in the available resources, five core models can assist with successful implementation of an outpatient DVT treatment program while providing optimum use of each site's resources and clinical expertise. These models are as follows: anticoagulation clinic (thromboembolic clinic-service), medical day care clinic, emergency department fast-track, one visit and self-injection, and physician-office follow-up. A program was implemented at Burnaby Hospital in May 1996 using the medical day care clinic model as a pilot. Formal evaluation of the program is still in progress but interim evaluation demonstrated overwhelming success.