Pulmonary Embolism, Acute — Goals and Metrics — Clinical Pathway: Emergency Department, ICU and Inpatient

Acute Pulmonary Embolism Clinical Pathway — Emergency Department, ICU and Inpatient

Goals

  • Standardize evaluation and initial management for patients with diagnosed pulmonary embolism on CTA or suspected PE with acute decompensation
  • Standardize risk stratification for patients with PE
  • Facilitate multi-disciplinary management for intermediate and high-risk patients via PE Response Team
  • Standardize outpatient follow up for patients with PE

Metrics

  • Proportion of patients diagnosed with PE who have full laboratory workup ordered prior to or within 2 hours of CTA
    • CBC, CMP, PT, PTT, fibrinogen, D-dimer, troponin, BNP
  • Proportion of patients with diagnosed PE who have an echo within appropriate time period per pathway
    • Low risk: < 24 hours after CTA result
    • Intermediate/high risk: < 6 hours after CTA result
  • Proportion with anticoagulation started < 2 hours after CTA result
    • Enoxaparin or heparin (bolus or infusion if no bolus given) given to patient (i.e., not just ordered) < 2 hours after CTA result
  • Time to therapeutic anticoagulation (for each drug individually)
    • If unfractionated heparin: time from start of bolus or infusion (if no bolus given) to first therapeutic PTT/heparin anti-Xa
    • If enoxaparin: time from first dose to first therapeutic enoxaparin anti-Xa
  • CTA quality (Quality will be denoted in the radiology reports going forward as: poor, adequate, fair, or excellent)
  • Percent of PE that is high or intermediate risk
  • In-hospital mortality
  • ICU admission (includes any PICU, CICU, NICU)
  • Length of stay (hospitalization LOS, ED LOS, ICU LOS)
  • Readmission within 30 days