Feasibility of a quality improvement project to increase adherence to evidence-based pulmonary embolism diagnosis in the emergency department.
Background: Many evidence-based clinical decision tools are available for the diagnosis of pulmonary embolism (PE). However, these clinical decision tools have had suboptimal uptake in the everyday clinical practice in emergency departments (EDs), despite numerous implementation efforts. We aimed to test the feasibility of a multi-faceted intervention to implement an evidence-based PE diagnosis protocol.
Methods: We conducted an interrupted time series study in three EDs in Ontario, Canada. We enrolled consecutive adult patients accessing the ED with suspected PE from January 1, 2018 to February 28, 2020. Components of the intervention were: clinical leadership endorsement; a new pathway for PE testing; physician education; personalized confidential physician feedback, and collection of patient outcome information. The intervention was implemented in November 2019. We identified six criteria for defining the feasibility outcome: successful implementation of the intervention in at least two of the three sites; capturing data on ≥ 80% of all CTPAs ordered in the EDs; timely access to electronic data; rapid manual data extraction with feedback preparation before the end of the month ≥ 80% of the time; time required for manual data extraction and feedback preparation ≤ 2 day per week in total.
Results: The intervention was successfully implemented in two out of three sites. 5,094 and 899 patients were tested for PE in the period before and after the intervention, respectively. We captured data from 90% of CTPAs ordered in the EDs, and we accessed the required electronic data. The manual data extraction and individual emergency physician audit and feedback were consistently finalized before the end of each month. The time required for manual data extraction and feedback preparation was ≤ 2 days per week (14 hours).
Conclusions: We proved the feasibility of implementing an evidence-based PE diagnosis protocol in two EDs. We were not successful implementing the protocol in the third ED.
Registration: The study was not registered.
Funding: CanVECTOR Network, McMaster Division of Hematology & Thromboembolism.
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Posted 15 Dec, 2020
On 04 Jan, 2021
On 02 Dec, 2020
On 01 Dec, 2020
On 01 Dec, 2020
On 01 Dec, 2020
On 09 Nov, 2020
Received 16 Oct, 2020
On 13 Oct, 2020
On 12 Oct, 2020
Invitations sent on 12 Oct, 2020
On 12 Oct, 2020
Received 12 Oct, 2020
On 11 Oct, 2020
On 11 Oct, 2020
Received 06 Sep, 2020
On 06 Sep, 2020
Received 20 Aug, 2020
On 18 Aug, 2020
On 15 Aug, 2020
Invitations sent on 23 Jul, 2020
On 20 Jul, 2020
On 19 Jul, 2020
On 19 Jul, 2020
On 16 Jul, 2020
Feasibility of a quality improvement project to increase adherence to evidence-based pulmonary embolism diagnosis in the emergency department.
Posted 15 Dec, 2020
On 04 Jan, 2021
On 02 Dec, 2020
On 01 Dec, 2020
On 01 Dec, 2020
On 01 Dec, 2020
On 09 Nov, 2020
Received 16 Oct, 2020
On 13 Oct, 2020
On 12 Oct, 2020
Invitations sent on 12 Oct, 2020
On 12 Oct, 2020
Received 12 Oct, 2020
On 11 Oct, 2020
On 11 Oct, 2020
Received 06 Sep, 2020
On 06 Sep, 2020
Received 20 Aug, 2020
On 18 Aug, 2020
On 15 Aug, 2020
Invitations sent on 23 Jul, 2020
On 20 Jul, 2020
On 19 Jul, 2020
On 19 Jul, 2020
On 16 Jul, 2020
Background: Many evidence-based clinical decision tools are available for the diagnosis of pulmonary embolism (PE). However, these clinical decision tools have had suboptimal uptake in the everyday clinical practice in emergency departments (EDs), despite numerous implementation efforts. We aimed to test the feasibility of a multi-faceted intervention to implement an evidence-based PE diagnosis protocol.
Methods: We conducted an interrupted time series study in three EDs in Ontario, Canada. We enrolled consecutive adult patients accessing the ED with suspected PE from January 1, 2018 to February 28, 2020. Components of the intervention were: clinical leadership endorsement; a new pathway for PE testing; physician education; personalized confidential physician feedback, and collection of patient outcome information. The intervention was implemented in November 2019. We identified six criteria for defining the feasibility outcome: successful implementation of the intervention in at least two of the three sites; capturing data on ≥ 80% of all CTPAs ordered in the EDs; timely access to electronic data; rapid manual data extraction with feedback preparation before the end of the month ≥ 80% of the time; time required for manual data extraction and feedback preparation ≤ 2 day per week in total.
Results: The intervention was successfully implemented in two out of three sites. 5,094 and 899 patients were tested for PE in the period before and after the intervention, respectively. We captured data from 90% of CTPAs ordered in the EDs, and we accessed the required electronic data. The manual data extraction and individual emergency physician audit and feedback were consistently finalized before the end of each month. The time required for manual data extraction and feedback preparation was ≤ 2 days per week (14 hours).
Conclusions: We proved the feasibility of implementing an evidence-based PE diagnosis protocol in two EDs. We were not successful implementing the protocol in the third ED.
Registration: The study was not registered.
Funding: CanVECTOR Network, McMaster Division of Hematology & Thromboembolism.
Figure 1
Figure 2
Figure 3
Figure 4