• Internal medicine journal · Mar 2011

    Comparative Study

    Study of compliance with a clinical pathway for suspected pulmonary embolism.

    • B J H Ng and S Lindstrom.
    • Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, Queensland, Australia. benjamin_ng@health.qld.gov.au
    • Intern Med J. 2011 Mar 1; 41 (3): 251-7.

    Background/AimsClinical pathways to guide the investigation of suspected pulmonary embolism have been increasingly adopted by emergency departments worldwide. This study evaluated the compliance with a clinical pathway that combines risk assessment (Wells score) with d-dimer, ventilation-perfusion scanning or computed tomographic pulmonary angiography (CTPA). The aims of this study were to identify factors that contribute to compliance and to assess patient outcomes and resource utilization.MethodsRepeated retrospective chart reviews of 239 patients who underwent investigation for pulmonary embolism through our emergency department extracted patient demographics, pathway parameters and patient outcomes. A phone interview at 3-month follow up was carried out.ResultsIncidence of pulmonary embolism was 8.4% (n= 20). Compliance to the clinical pathway occurred in 120 subjects (50.2%). Non-compliance occurred in 71 subjects (29.7%). Forty-eight subjects (20.1%) underwent risk assessments, but subsequent diagnostic tests did not conform to the stated pathway (partial compliance). Compliance was poor in subjects assessed by non-emergency department doctors (χ(2) = 27.95, P≤ 0.001). Compliance occurred less in pregnant subjects (χ(2) = 7.27, P= 0.007) and those with chronic respiratory disease (χ(2) = 5.31, P= 0.021). Subjects in the compliant group were less likely to undergo CTPA (odds ratio 2.07 (1.16-3.70), P= 0.012).ConclusionsCompliance with this clinical pathway allowed emergency department doctors in an Australian university teaching hospital to complete diagnostic testing for suspected pulmonary embolism appropriately unless non-emergency department doctors became involved. Compliance with this pathway altered the distribution of diagnostic tests performed with less reliance on CTPA, but was not associated with better patient outcomes.© 2011 The Authors. Internal Medicine Journal © 2011 Royal Australasian College of Physicians.

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