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Feasibility of a quality improvement project to increase adherence to evidence-based pulmonary embolism diagnosis in the emergency department.
Federico Germini
McMaster University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0802-3616
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Pilot and Feasibility Studies.
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.
Keywords
pulmonary embolism, emergency department, interrupted time series
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CURRENT STATUS: Published
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Posted 15 Dec, 2020
Published
On 04 Jan, 2021
No community comments so far
Editorial decision: Accept
On 02 Dec, 2020
Editor assigned
On 01 Dec, 2020
Submission checks complete
On 01 Dec, 2020
Editor invited
On 01 Dec, 2020
No comments provided
Editorial decision: Minor revision
On 09 Nov, 2020
Review #2 received
Received 16 Oct, 2020
Reviewer #2 agreed
On 13 Oct, 2020
Editor assigned
On 12 Oct, 2020
Reviewers invited
Invitations sent on 12 Oct, 2020
Reviewer #1 agreed
On 12 Oct, 2020
Review #1 received
Received 12 Oct, 2020
Submission checks complete
On 11 Oct, 2020
Editor invited
On 11 Oct, 2020
No comments provided
Review #2 received
Received 06 Sep, 2020
Editorial decision: Major revision
On 06 Sep, 2020
Review #1 received
Received 20 Aug, 2020
Reviewer #2 agreed
On 18 Aug, 2020
Reviewer #1 agreed
On 15 Aug, 2020
Reviewers invited
Invitations sent on 23 Jul, 2020
Editor assigned
On 20 Jul, 2020
Submission checks complete
On 19 Jul, 2020
Editor invited
On 19 Jul, 2020
First submitted
On 16 Jul, 2020
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This preprint is under consideration at Pilot and Feasibility Studies. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Feasibility of a quality improvement project to increase adherence to evidence-based pulmonary embolism diagnosis in the emergency department.
Federico Germini
McMaster University
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0802-3616
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 3
Posted 15 Dec, 2020
Published
On 04 Jan, 2021
No community comments so far
Editorial decision: Accept
On 02 Dec, 2020
Editor assigned
On 01 Dec, 2020
Submission checks complete
On 01 Dec, 2020
Editor invited
On 01 Dec, 2020
No comments provided
Editorial decision: Minor revision
On 09 Nov, 2020
Review #2 received
Received 16 Oct, 2020
Reviewer #2 agreed
On 13 Oct, 2020
Editor assigned
On 12 Oct, 2020
Reviewers invited
Invitations sent on 12 Oct, 2020
Reviewer #1 agreed
On 12 Oct, 2020
Review #1 received
Received 12 Oct, 2020
Submission checks complete
On 11 Oct, 2020
Editor invited
On 11 Oct, 2020
No comments provided
Review #2 received
Received 06 Sep, 2020
Editorial decision: Major revision
On 06 Sep, 2020
Review #1 received
Received 20 Aug, 2020
Reviewer #2 agreed
On 18 Aug, 2020
Reviewer #1 agreed
On 15 Aug, 2020
Reviewers invited
Invitations sent on 23 Jul, 2020
Editor assigned
On 20 Jul, 2020
Submission checks complete
On 19 Jul, 2020
Editor invited
On 19 Jul, 2020
First submitted
On 16 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Pilot and Feasibility Studies.
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