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BMJ Quality Improvement report
Effectiveness of a submassive pulmonary embolism protocol to standardise patient evaluation and treatment
  1. Kelly Galanos1,
  2. Cassie Jaeger2,
  3. Kevin Coakley3,
  4. Peter White4,
  5. David Griffen1
  1. 1 Division of Emergency Medicine, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
  2. 2 Department of Operations Improvement, Memorial Health System, Springfield, Illinois, USA
  3. 3 Department of Radiology, Southern Illinois University School of Medicine, Springfield, Illinois, USA
  4. 4 Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
  1. Correspondence to Dr Cassie Jaeger; Hawk.Cassie{at}mhsil.com

Abstract

Treatment recommendations for submassive pulmonary embolus (SMPE), defined as pulmonary embolus (PE) resulting in right ventricular dysfunction and/or myocardial necrosis, vary. The objective of this study was to develop an investigative protocol at our tertiary care hospital to standardise the approach to patients with SMPE and to evaluate the effect of the protocol on process measures including consultation with cardiology and critical care physicians and time to echocardiogram and treatment. Triggered by right ventricle/left ventricle ratios >0.9, the protocol standardised ancillary studies and immediate consultation with critical care and cardiology. Post-protocol implementation, the percent of patients with SMPE evaluated by critical care specialists increased from 26% (19/74) to 93% (41/44) (p<0.001) and cardiology consultations increased from 35% (26/74) to 89% (39/44) (p<0.001). Patient arrival to echocardiogram was reduced from 15 hours to 5 hours post-protocol implementation. In addition, average time to anticoagulation was reduced from greater than 7 hours to 3 hours 27 min post-protocol implementation. The protocol has helped to identify patients with SMPE and standardise the care they receive after diagnosis.

  • emergency department
  • healthcare quality improvement
  • shared decision making

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjoq-2017-000279

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    Footnotes

    • Contributors KG contributed to study concept and design, acquisition of data, analysis and interpretation of data and drafting and critical revision of the manuscript. CJ contributed to acquisition of data, drafting and critical revision of the manuscript and statistical expertise. KC contributed to acquisition, analysis and interpretation of the data. PW contributed to study concept and design and study supervision. DG contributed to study concept and design, analysis and interpretation of data, drafting and critical revision of the manuscript and study supervision. All contributors reviewed the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.