Background Studies have suggested that outpatient (OP) management of suspected pulmonary embolism (PE) is feasible.1 At our DGH (popn 289,400) the decision to manage a suspected PE as an OP is made clinically by the admitting physician. The aims of our study were
To ascertain the proportion of patients who underwent CTPA investigation that were managed as outpatients and subsequent nights saved.
To identify any further patients that could have been managed as OP and potential nights that could have been saved.
To determine if the outpatients met the current criteria for ambulatory management of PE.
Methods RADIS was used to collect all CTPA’s performed between 1st September 2011 and 31st October 2011.Notes were requested.
Inclusion criteria Ambulatory, normal heart rate, respiratory rate, blood pressure and oxygen saturations (on air),any patient who was managed acutely as an OPPESI Score < 85.2
Exclusion criteria Any pre-existing in-patient that had a CTPA ordered where the primary admission (and reason for in-patient stay) was not for suspected PE, any patient who had their CTPA on the same day of discharge, OP CTPA where waiting time was > 2 weeks. PESI Score > 85.2
Results For the above period 105 CTPA’s were performed. Average time from request to CTPA was 4.1 hours (1–21 hours.) Figure 1 shows the excluded patients. 15 patients were included; 7 were female, average age 47 years(18–78 years).All had a PESI score <85.11 were investigated as outpatients (1 PE +ve) and 4 were kept as inpatients(2 PE +ve). The 11 managed as outpatients resulted in 17 nights saved. The 4 inpatients (if managed as OP) could have saved an additional 6 nights.
Conclusion Over a 2 month period at our DGH most suspected PE patients (suitable for ambulatory care) are being identified resulting in significant (17 nights) bed savings.
Hogg K et al, Emerg Med J 2006; 23:123–127.
Aujesky D et al, AJRCCM 2005; 172(8):1041.