How Tasmanian Emergency Departments ‘Choose Wisely’ When Investigating Suspected Pulmonary Embolism
Abstract
:1. Introduction
Choosing Wisely
2. Materials and Methods
2.1. Study Design
2.2. Data Collection
2.3. Data Analysis
2.4. Ethics
3. Results
3.1. Participant and Site Demographics/Characteristics
3.2. CPG Use and Adherence
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Hospital A n = 1009 (36.6%) | Hospital B n = 419 (15.2%) | Hospital C n = 730 (26.5%) | Hospital D n = 600 (21.8%) | Total n = 2758 | ||
---|---|---|---|---|---|---|
Age (mean) | 59.92 | 60.68 | 61.00 | 61.12 | 60.58 | |
Gender | ||||||
Male | 424 (42.0%) | 171 (40.8%) | 330 (45.2%) | 245 (40.8%) | 1170 (42.4%) | |
Female | 585 (58.0%) | 248 (59.2%) | 400 (54.8%) | 355 (59.2%) | 1588 (57.6%) | |
Presenting Complaint | ||||||
SOB | 66.8% | 65.2% | 64.5% | 62.0% | 69.4% | |
Chest Pain | 60.3% | 58.7% | 63.8% | 68.0% | 67.0% | |
Palpitations/Tachycardia | 33.1% | 31.5% | 32.3% | 30.3% | 34.3% | |
Other | 37.8% | 31.0% | 31.5% | 25.5% | 34.7% |
Hospital A N = 1009 | Hospital B N = 419 | Hospital C N = 730 | Hospital D N = 600 | Total N = 2758 | |
---|---|---|---|---|---|
ED attendance during the study period | 90,564 | 39,617 | 64,857 | 41,750 | 236,788 |
Scans positive for PE (yield) | 162 (16.1%) | 49 (11.7%) | 83 (11.4%) | 49 (8.2%) | 343 (12.4%) |
CTPAs conducted/1000 ED attendances | 11.14 | 10.58 | 11.26 | 14.37 | 11.65 |
Yield/1000 ED attendances | 1.79 | 1.24 | 1.28 | 1.17 | 1.45 |
Length of stay (mins) in ED (mean) | 590.48 | 492.50 | 823.77 | 466.99 | 606.46 |
Hospital A n = 1009 | Hospital B n = 419 | Hospital C n = 730 | Hospital D n = 600 | Total n = 2758 | ||
---|---|---|---|---|---|---|
Clinical practice guidelines documented before the scan | 176 (17.4%) | 30 (7.2%) | 73 (10.0%) | 47 (7.8%) | 326 (11.8%) | |
D-dimer used before the scan | 538 (53.3%) | 144 (34.4%) | 267 (36.6%) | 237 (39.5%) | 1186 (43.0%) | |
D-dimer result | ||||||
Positive | 510 (94.8%) | 129 (89.6%) | 243 (91.0%) | 213 (90.3%) | 1095 (92.4%) | |
Negative | 28 (5.2%) | 15 (10.4%) | 24 (9.0%) | 23 (9.7%) | 90 (7.6%) | |
Age-adjusted D-dimer result (for >50 years) | ||||||
Positive | 297 (83.2%) | 76 (80.0%) | 132 (71.7%) | 107 (67.3%) | 612 (77.0%) | |
Negative | 60 (16.8%) | 19 (20.0%) | 52 (28.3%) | 52 (32.7%) | 183 (23.0%) |
Clinician Level | Consultant | Registrar | Resident | Intern | Unknown |
---|---|---|---|---|---|
CTPAs ordered + conducted | 424 (15.4%) | 1366 (49.5%) | 511 (18.5%) | 423 (15.3%) | 34 (1.2%) |
Yield (% of all scans ordered by that clinician level) | 56 (13.2%) | 172 (12.6%) | 70 (13.7%) | 41 (9.7%) | 4 (11.8%) |
Clinical practice guidelines documented before the scan | 29 (6.8%) | 149 (10.9%) | 69 (13.5%) | 75 (17.7%) | 5 (14.7%) |
D-dimer used before the scan | 186 (43.9%) | 613 (44.9%) | 202 (39.5%) | 176 (41.6%) | 9 (26.5%) |
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Thurlow, L.E.; Van Dam, P.J.; Prior, S.J.; Tran, V. How Tasmanian Emergency Departments ‘Choose Wisely’ When Investigating Suspected Pulmonary Embolism. Healthcare 2023, 11, 1599. https://doi.org/10.3390/healthcare11111599
Thurlow LE, Van Dam PJ, Prior SJ, Tran V. How Tasmanian Emergency Departments ‘Choose Wisely’ When Investigating Suspected Pulmonary Embolism. Healthcare. 2023; 11(11):1599. https://doi.org/10.3390/healthcare11111599
Chicago/Turabian StyleThurlow, Lauren E., Pieter J. Van Dam, Sarah J. Prior, and Viet Tran. 2023. "How Tasmanian Emergency Departments ‘Choose Wisely’ When Investigating Suspected Pulmonary Embolism" Healthcare 11, no. 11: 1599. https://doi.org/10.3390/healthcare11111599