New and improved standard for care in Nova Scotia reduces wait times and sees increase in patient satisfaction

The Challenge: Misconnections occur as patients move beyond primary care

The process of moving patients from primary care to treatment provided by specialists is plagued by misconnections, which are costly to healthcare authorities and frustrating to patients and caregivers. Treatment of deep-vein thrombosis (DVT) is a particularly vexing problem, as the process requires family doctors to follow various methods and involve specialists from several disciplines.

The Improvement Project: Study DVT to organize all care from patients’ perspective

Sam Campbell, Director of Quality Improvements, Emergency Medicine at Queen Elizabeth II Health Sciences Centre in Halifax, set out to improve the transition of patients from primary to secondary care by investigating instances when patients with DVT are referred to emergency departments. In carrying out his evidence-based study, the department of emergency medicine not only wanted to find ways to help family doctors manage their patients, but also remove from all physicians their self-imposed labels as primary and secondary care providers and encourage them to organize their care from the perspective of patients’ needs.

The Result: Evidence-based protocols lead to reliable treatment pathway

Campbell’s work enabled him to establish evidence-based protocols for DVT diagnosis and treatment as part of his EXTRA improvement project. He used the protocols to adapt an existing scoring tool and create a new patient-centred pathway that makes it possible for family physicians to determine patients’ clinical probability of disease and take appropriate responses. Following this step-by-step pathway, family doctors can diagnose and treat most patients themselves. In cases where patients must be referred to emergency departments, the pathway also helps advanced-care paramedics and emergency physicians evaluate the severity of cases accurately, thereby avoiding taking resources away from other emergency patients unnecessarily.

The Impact: A new standard of care for DVT diagnosis and treatment

After one year, family physicians who had used the pathway rated it 8.99 out of 10. Ninety-five percent of emergency physicians were “very satisfied” with it, as were 89 percent of the advanced care paramedics surveyed. Nearly all patients raved about the pathway. Surveys show that 95 percent of patients contacted were “very satisfied” with their experiences. No wonder. As a result of the pathway, patients referred to emergency saw the length of their stays decrease by more than an hour and a half. Capitalizing on this success, the pathway is now standard for DVT diagnosis and treatment and is being used as a model for developing similar approaches in other areas.

Sam Campbell image Sam Campbell
Director of Quality Improvements, Emergency Medicine
Queen Elizabeth II Health Sciences Centre
Halifax, Nova Scotia


To learn more about this project or the EXTRA program, visit or email us at