Think FAST: Jefferson Transition-of-Care Program Deemed Safe and Effective Alternative to Hospital Stay for Certain DVT Patients
A multidisciplinary team at Thomas Jefferson University Hospitals implemented a successful transition-of-care program, Jefferson Facilitating Anticoagulation for Safer Transitions, or Jeff FAST, for patients presenting to the emergency room with acute, uncomplicated deep vein thrombosis (DVT).
"We compared a number of cases of DVT before and after we implemented the Jeff FAST program," said Geno J. Merli, M.D., Senior Associate Chief Medical Officer at Thomas Jefferson University Hospitals. "We found that for some patients, outpatient care is safe and patients can avoid a hospital stay. Our publication defines the model for assessing and treating patients with blood clots in the emergency department and discharging them home."
Dr. Merli and his team used evidenced-based guidelines to determine which patients could be discharged safely and which should be admitted to the hospital. Some factors include co-morbidities, prolonged immobilization and social support. Emergency Medicine physicians use the guidelines as a tool, in addition to their clinical judgment, while making the admission decision.
If discharge is appropriate, the patient and their caregiver receive education before leaving the hospital and staff ensure they are able to fill the prescription. In addition, a follow-up visit is scheduled prior to discharge. Patients are then called 3-5 days after discharge and then again at 30 days. The phone calls ensure the well-being of the patient and also provide time to reinforce anticoagulation education.
"Patient education is a key component of the Jeff FAST program. We verify the patient's ability to pay for and access their medication and review how the medication works, how to take it, as well as possible side effects," said Laura Falconieri, Pharm.D., and first author. "With the right education, for the right patients, this condition can be safely managed on an outpatient basis."
Education for providers, also integral to the success of the program, is enhanced with a Jeff FAST application for smartphones, currently in development. The app will provide just-in-time information so that emergency room physicians can make the best informed decisions.
The authors will continue to monitor and update the program to ensure its continued success and sustainability.
Conflict of Interest Statement: Lynda Thomson, PharmD, CACP, discloses a conflict of interest with Pfizer. Glenn Oettinger, PharmD, BCPS, and Michael Palladino, PharmD, MBA, CACP, disclose a conflict of interest with Janssen. Geno Merli, MD, discloses conflicts of interest with BMS, Johnson & Johnson, Portola, and sanofi-aventis. Laura Falconieri, PharmD, Robert Pugliese, PharmD, BCPS, and Taki Galanis, MD, disclose no conflicts of interest.
Article Reference: Reprinted Hospital Practice, Volume 42 Number 4, Laura Falconieri, PharmD; Lynda Thomson, PharmD, CACP; Glenn Oettinger, PharmD, BCPS; Robert Pugliese, PharmD, BCPS; Michael Palladino, PharmD, MBA, CACP; Taki Galanis, MD; Geno Merli, MD. Facilitating Anticoagulation for Safer Transitions: Preliminary Outcomes From an Emergency Department Deep Vein Thrombosis Discharge Program, Pages 16-45, 2014.
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