Summary
This National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report reviews the quality of care of patients aged 16 and over who had a pulmonary embolism (PE), The study aimed to highlight areas where care could be improved in patients with a new diagnosis of acute PE.
A retrospective case note and questionnaire review was undertaken in 526 patients aged 16 and over who had a PE, and who either presented to hospital or developed a PE whilst an inpatient for another condition.
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Content
Key findings
- One delay or more in the process of care was identified in 161/420 (38.3%) patients, with recognition, investigations and treatment being the most common.
- The primary treatment for PE is anticoagulation. It is imperative that this is started as soon as possible. Where there might be a delay to the diagnosis of acute PE anticoagulation should be commenced. In this study the case reviewers reported an avoidable delay in commencing treatment in 90/481 (18.7%) patients.
- Once PE has been diagnosed an assessment of PE severity needs to be undertaken in order to treat patients effectively. In 144/179 (80.4%) hospitals their PE policy/guideline included the assessment of PE severity.
- This severity assessment was based on a validated scoring system such as PESI or Hestia in 128/142 (90.1%) hospitals. Case reviewers found no evidence of a PE severity assessment in the majority of patients (436/483; 90.3%).
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Severe (massive) PE requires additional or alternative treatment. A guideline/protocol for the diagnosis and care of patients with PE
was provided at 151/180 (83.9%) hospitals. - Ambulatory care has recently become a recognised pathway for PE management in those patients with low-risk of adverse outcomes. An ambulatory care pathway was used for all or part of the patient journey in 77/474 (16.2%) patients in this study. Wide variation in the selection of patients for ambulatory care was observed, with some high-risk patients being selected on this pathway and low-risk patients not being considered for it, resulting in unnecessary hospital admissions.
- Patients should receive all the information they need to make an informed choice, particularly with respect to taking anticoagulation. Treating clinicians were unable to determine if the patient was given verbal or written information regarding PE in 336/600 (56.0%) instances and specific information/ education regarding PE was not routinely provided to patients at 55/167 (32.9%) hospitals.
- An outpatient follow-up was not routinely arranged following a PE diagnosis in 32/179 (17.9%) hospitals.
NCEPOD report - Pulmonary embolism: Know the Score (10 October 2019)
https://www.ncepod.org.uk/2019pe.html
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