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Abstract
Background Studies have suggested that outpatient (OP) management of suspected pulmonary embolism (PE) is feasable.1 At our DGH (popn 289400) in 2012 we found that over a 2 month period most suspected PE patients (suitable for ambulatory care) were being identified resulting in significant (17 nights) bed savings.2
The aims of repeating our study were
1) to ascertain the proportion of patients who had a CTPA that were managed as OP and subsequent nights saved 2) to identify any further patients that could have been managed as OP and potential nights saved 3) a comparison with 2012
Methods RADIS was used to collect all CTPA’s performed between 1st Jan 2014 and 28th February 2014. Inclusion criteria: Ambulatory, normal heart rate, respiratory rate, blood pressure and oxygen saturations, any patient who was managed as an OP. Simpflified PESI Score <1. Exclusion criteria: Pre-existing in-patients that had a CTPA ordered where the primary admission (and in-patient stay) was not for suspected PE,patients who had their CTPA on the same day of discharge, OP CTPA where waiting time was >2 weeks, sPESI Score >1, clinical concern.
Results For the above period 102 CTPA’s were performed (105 in 2012). Average time from request to CTPA was 4.7 h (0.5–24 h. 4.1 hrs in 2012) Figure 1 shows the excluded patients.9 patients were included;7 were female, average age 47 years (23–66 years). All had a sPESI score
Conclusion The number of ambulatory patients investigated for PE has reduced from 2012 to 2014 which probably reflects an increased acute physician presence at our DGH but some bed savings (7 nights over our 2 month period) were still made. Over 2 years approximately 180 ambulatory patients have been investigated and managed for PE at our DGH with no adverse incidents to date.
References
Hogg K et al. Emerg Med J 2006;23:123–127
Benjamin JA et al. Thorax 2012;67:A123
Flowchart of outcomes of all CTPA’s collected during 2014 and 2012