In 2015 Dr R Limbrey (Respiratory Physician) and Sr S.Goodman (CNS Pulmonary Vascular Service) set up a Nurse Led (new patient) Pulmonary Embolism (P.E) clinic to support increasing demand on the traditional model of consultant care.
We aim for a CNS review of all new patients with P.E at 3 weeks following diagnosis, and provide follow up for 2 years. Previously a CNS led follow up clinic was in place.
We aim to provide our patients with early high quality education and information to reduce anxiety, improve physical functioning and quality of life. We suggest that this will reduce perceived ongoing symptoms and lessen follow up requirement.
Referral is made electronically. The referral system has been developed as a learning opportunity to enable medical referrers to identify provoking factors and quantify risk associated with the event. The data obtained from referrals provides support for service provision.
In 2015, 260 patients were reviewed in the Nurse led clinic, 95 of these were new referrals.
Of the 95 new referrals to the service 54 (57%) were provoked by an identifiable transient provoking factor. ESC (2014). Of these 42 (78%) also had persistent risk factors by ESC
The remaining 41 (43%) had no identifiable transient provoking factor. Of these 32 (78%) did have persistent risk factors as per ESC 2014.
We note that 44% of all identified PE patients in this cohort, provoked and unprovoked, had a BMI ≥ 30kg/m2
In the provoked group 16 new patients were reviewed and discharged after an average of 2.62 appointments per person with an additional telephone review planned at the 2 year point.
In the unprovoked group 12 patients have been discharged to date with an average of 3.3 appointments per person with an additional telephone review planned for the 2 year mark.
The remainder of these patients can reasonably be expected to be discharged from follow up with similar levels of review.
Feedback from our patients has been overwhelmingly positive, most commonly expressed as a significant reduction in anxiety and improvement in quality of life.