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“Pulmonary Embolism: Know the Score” – Can we standardise care to improve patient outcomes?
Poster Title: “Pulmonary Embolism: Know the Score” – Can we standardise care to improve patient outcomes?
Submitted on 30 Oct 2020
Author(s): Kotb H, Nelson D, Oseni A, Bessame K, Smith L, Srikanthan A, Rhodes A
Affiliations: Kingston Hospital NHS Foundation Trust
Poster Views: 522
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Poster Information
Abstract: ‘Pulmonary Embolism: Know the score’- improve CT Pulmonary Angiogram (CTPA) reporting to improve patient outcomes?

The 2019 NCEPOD report ‘Pulmonary Embolism: Know the score’ advocates standardisation of care to improve patient outcomes.

Recommendations include proforma reporting of CTPA to assess clot burden and evidence of right heart strain (RHS); urgent communication of results; calculating the PE severity index (PESI) and echocardiography to determine clinical severity of PE and patient’s risk of morbidity/mortality to guide management, including use of ambulatory pathways.
A retrospective, in-patient CTPA audit in November 2019 informed radiologists in reports requirements. A reporting proforma was introduced.
Re-audit in February-May 2020 excluded patients with CT features of COVID-19 pneumonia.
Inclusion of study quality (e.g. adequate contrast enhancement of pulmonary arteries), clot burden, features of RHS and evidence of urgent communication of PE were collected from reports.
PESIs and use of echocardiography were collected from CRS records.

149 CTPAs reviewed

3% reports on proforma
21% positive for PE (RCR standards >15.4%)
71% (53% Nov 2019) reported study adequacy
74% (70% Nov 2019) reported RHS
58% (23% Nov 2019) Clinicians immediately informed of PE diagnosis

52% PEs were ‘massive’ based on clot burden and presence of RHS.
PESI scores were recorded in 31% and 58% of patient had in-patient echocardiography. One patient with massive PE was ambulated (PESI- class 1).

Quality improvement has been demonstrated via the audit cycle.
Default proforma reporting is being explored via Soliton.
Urgent communication of results was not recorded on out-sourced reports (17%). An electronic solution is being explored. Data sharing with the clinical teams is hoped to improve PESI use, to guide ambulatory care.
Summary: ‘Pulmonary Embolism: Know the score’- can we improve CT Pulmonary Angiogram (CTPA) reporting to standardise care and improve patient outcomes?References: 1. Know the Score: A review of the quality of care provided to patients aged over 16 years with a new diagnosis of pulmonary embolism. National Confidential Enquiry into Patient Outcome and Death, (2019)
2. National Institute for Health and Care Excellence (NICE Guidelines CG144). Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. London: National Institute for Health and Care Excellence, 2012 (updated in 2015).
3. The Royal College of Radiologists (RCR: 7th Edition iRefer Guidelines CC04). Suspected Pulmonary Embolism (PE) London: The Royal College of Radiologists, 2012.
4. Kingston Hospital (2019). [Blue Book Version 19]. Retrieved from: /media/9739/t-secure-department-folders-governance-department-policies-guidelines-publishing-transfer-to-pcg-pdfs-only-patient-care-experience-blue-book-october-2019-v17.pdf
5. Withey S, Tamimi A, CT pulmonary angiogram reporting for pulmonary embolism: are we informing clinical management? ECR Poster C-0
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