Patient #1 presented by ambulance and was triaged as “level 4” with complaints of left leg pain and pain behind the knee for several days. The pain was described as a sharp pain radiating from lower left leg to the thigh area. The PA ordered a D-dimer test for possible blood clot.
When the test results came back with values indicating a possible blood clot, policies and procedures indicated that a vascular ultra sound was to be performed. Policies also indicated that ultrasound services were to be available 24/7, but in practice, it appeared that no technicians were on-call on the weekends. Practice under these circumstances were found to be to administer a Lovenox anti-coagulant shot and have the patient receive an ultrasound on Monday morning.
The patient refused the injection until he could receive an ultrasound at another hospital, and left the facility with discharge orders to return Monday morning for an ultrasound and to take Lovenox twice daily. The medical record documented the patient as stable at discharge, although no treatment had been rendered for as suspected DVT.
The investigators compared the treatment of Patient 1 and another leg pain with possible DVT and found that the treatments were inconsistent.
A2407-NJ-2013-4-11