Background: We found that emergency physicians do not always use D-dimer for pulmonary embolism (PE) testing. We implemented PE testing pathway which required D-dimer testing for all patients suspected of having PE.
Aims: To evaluate the adherence to and clinical impact of the new PE testing pathway.
Methods: We enrolled consecutive adult patients tested for PE between January 2018 and January 2021 in two Canadian emergency departments. In November 2019, we implemented a new PE testing pathway. Outcomes before and after the intervention were compared using two-level generalized linear model, adjusting for patient age and gender, time of the day (day vs night-time), days of week (weekdays vs weekend), physician gender and years of experience and study site. Adjusted odds ratio (aOR) are presented with the relative 95% confidence intervals.
Results: 5085/70,911 (7.2%) eligible patients were tested for PE before the intervention, 3854/36,530 (10.6%) after, with an aOR of 1.42 (1.35, 1.50). The aOR for following the protocol was 3.10 (2.53, 3.80), for use of imaging 1.01 (0.92, 1.11), imaging positive yield 0.97 (0.79, 1.19), use of imaging in patients with a negative D-dimer 0.28 (0.23, 0.35), PE diagnosis among tested patients 0.98 (0.81, 1.19), central PE (segmental or more proximal) among all PEs 1.44 (0.80, 2.58). The false negative rate for PE testing was 4/5085 (0.08%) before and 1/3854 (0.03%) after intervention [percentage difference of -0.05 (-0.15, 0.04)].
Conclusions: Implementation of a new PE testing pathway was associated with an increase in PE testing, improved adherence to D-dimer use and no change in imaging use or PE testing yield.
To cite this abstract in AMA style:Germini F, Al-haimus F, Hu Y, Niaz S, Clayton N, Mondoux S, Ibrahim Q, Thabane L, de Wit K. Pulmonary Embolism Diagnosis: Let’s Practice what we Preach. A Quality Improvement Study to Increase Adherence to Evidence-based PE Diagnosis in the Emergency Department [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/pulmonary-embolism-diagnosis-lets-practice-what-we-preach-a-quality-improvement-study-to-increase-adherence-to-evidence-based-pe-diagnosis-in-the-emergency-department/. Accessed December 6, 2023.
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