(P52) Ultrasound at an Assisted Living Facility Reduces Emergency Room Visits

Objective/Aim: The aim is to decrease emergency room visits and possible hospitalization for residents in our ALF who have a moderate Well’s Criteria score for DVT (deep venous thrombosis), thereby also reducing resident health burden and reducing cost.

Background: Concern for DVT has the potential for emergency room visits if resources are not available to sufficiently rule them out. Long-term care facilities do not always have the on-site testing necessary to manage a resident with this concern, leading to a high number of emergency room visits that could otherwise be avoided. If a same-day lab is not available to obtain a D-dimer level, residents may need evaluation in an emergency room for moderate likelihood of DVT. The Well’s score for DVT is the most widely validated set of criteria for calculating risk of DVT. When following this criteria, if a D-dimer level is not available, an emergency room visit can still be avoided if there is on-site doppler ultrasound available.

Quality Improvement

Methods: At our ALF blood draws are not readily available. They are completed once weekly and occur on the same day every week. Therefore, if there is concern for a DVT, it is not typically possible for a same day D-dimer to be drawn. This ultimately leads to unnecessary emergency room visits. If doppler ultrasound was instead readily available on site, this could decrease unnecessary emergency room visits. If negative, this could rule-out DVT in many cases and stop further work-up. If positive, many residents could be started on a blood thinner medication and avoid further work-up in an emergency room. Here, we look at the number of times a doppler ultrasound was used on residents on-site between February 2021 and October 2022.

Results: 10 on-site lower extremity doppler ultrasounds were performed on residents with a moderate Well’s score. Of these, all 10 ultrasounds were negative for DVT. None of these residents were sent to the emergency room or hospitalized.

Conclusions: On-site doppler ultrasound at an ALF is an efficient, safe, and cost-effective way to manage residents with a moderate Well’s score. This testing can be done the same day and therefore reduce emergency room visits and possible hospitalization.