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2018 ; 7
(3
): e000279
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gab.com Text
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Effectiveness of a submassive pulmonary embolism protocol to standardise patient
evaluation and treatment
#MMPMID30057955
Galanos K
; Jaeger C
; Coakley K
; White P
; Griffen D
BMJ Open Qual
2018[]; 7
(3
): e000279
PMID30057955
show ga
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.