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British Thoracic Society Quality Standards for outpatient management of pulmonary embolism
  1. Robin Condliffe1,
  2. Paul Albert2,
  3. Raza Alikhan3,
  4. Emma Gee4,
  5. Daniel Horner5,
  6. Laura Hunter6,
  7. Phillip Jacobs7,
  8. Rachel Limbrey8,
  9. Michael Newnham9,
  10. Wendy Preston10,
  11. Sheena Patel11,
  12. Laura-Jane Smith12 and
  13. Jay Suntharalingam13
  1. 1Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  2. 2Respiratory Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
  3. 3Haematology, University Hospital of Wales, Cardiff, UK
  4. 4Thrombosis and Coagulation, King's College Hospital, London, UK
  5. 5Emergency Medicine, Salford Royal NHS Foundation Trust, Salford, UK
  6. 6Emergency Medicine, St Thomas' Hospital, London, UK
  7. 7Royal Free London NHS Foundation Trust, Barnet, UK
  8. 8Respiratory Medicine, Southampton General Hospital, Southampton, UK
  9. 9Respiratory Medicine, Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, UK
  10. 10Respiratory Medicine, George Eliot Hospital NHS Trust, Nuneaton, Warwickshire, UK
  11. 11Anticoagulation and Medication Safety/Clinical Governance, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  12. 12Respiratory Medicine, Kings College Hospital, London, UK
  13. 13Respiratory Medicine, Royal United Hospital Bath NHS Trust, Bath, UK
  1. Correspondence to Dr Robin Condliffe; robin.condliffe{at}sth.nhs.uk

Abstract

Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for outpatient management of pulmonary embolism in the UK, together with measurable markers of good practice. Quality statements are based on the British Thoracic Society (BTS) Guideline for the Initial Outpatient Management of Pulmonary Embolism.

Methods Development of BTS Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards.

Results Six quality statements have been developed, each describing a standard of care for the outpatient management of pulmonary embolism in the UK, together with measurable markers of good practice.

Discussion BTS Quality Standards for Outpatient Management of Pulmonary Embolism form a key part of the range of supporting materials that the society produces to assist in the dissemination and implementation of a guideline’s recommendations.

  • pulmonary embolism
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Introduction

The British Thoracic Society (BTS) has been at the forefront of the production of guidelines for best clinical practice in respiratory medicine since the Society was established over 30 years ago. Guideline production methodology has evolved considerably in recent years, and a manual setting out the detailed policy for the production of BTS Guidelines is reviewed annually by the BTS Standards of Care Committee (SOCC). BTS Guidelines received National Institute for Health and Care Excellence (NICE) accreditation in 2011. The production of quality standards based on each BTS Guideline is a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of a guideline’s recommendations. The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the outpatient management of acute pulmonary embolism (PE) in the UK, together with measurable markers of good practice. BTS Quality Standards are intended for:

  • Healthcare professionals to allow decisions to be made about care based on the latest evidence and best practice.

  • People with respiratory disease and their families and carers to enable understanding of what services they should expect from their health and social care provider.

  • Service providers to be able to quickly and easily examine the clinical performance of their organisation and assess the standards of care they provide.

  • Commissioners (or equivalent in Scotland and Northern Ireland) so that they can be confident that the services they are purchasing are high quality and cost-effective.

NICE Quality Standards were used as a model for the development of BTS Quality Standards, and the development of these quality standards is based on the NICE Quality Standards Process Guide.1 This document contains quality standards for the outpatient management of PE. This document was approved by the BTS SOCC in March 2020.

A quality standard is a set of specific, concise statements that:

  • act as markers of high-quality, cost-effective patient care across a pathway or clinical area, covering treatment or prevention;

  • are derived from the best available evidence.

The development of these quality standards was stimulated, in part, by the National Confidential Enquiry into Patient Outcome and Death: Know the Score 2019 (https://www.ncepod.org.uk/2019pe.html), which was published in October 2019.

The BTS Quality Standards include evidence and recommendations summarised in the BTS Guideline for the Initial Outpatient Management of Pulmonary Embolism (PE), which was published in 2018.2

Each quality standard includes the following:

  • A quality statement, which describes a key marker of high-quality, cost-effective care for this condition.

  • Quality measures, which aim to improve the structure, process and outcomes of healthcare.

The quality measures are not intended to be new sets of targets or mandatory indicators for performance management that need to be collected. The quality measures are specified in the form of a numerator and a denominator, which define a proportion or ratio (numerator/denominator). It is assumed that the numerator is a subset of the denominator population. The suggested numerator and denominator are provided to allow healthcare professionals and service providers to examine their clinical performance in relation to each quality standard. It is recognised that no national quality indicators will be available for this condition, and institutions will need to agree locally what information is required for the denominator to be used in each case and what the expected level of achievement should be, given local circumstances. A brief description about the quality standard in relation to each audience is given.

The main source reference for these Quality Standards is the BTS Guideline for the initial outpatient management of PE, 2018.2 There is no specific order of priority associated with the list of quality statements.

Method of working

A Quality Standards Working Group was convened in November 2018 and met in January 2019. Table 1 shows the membership of the group. Members of the Quality Standards Group submitted Declaration of Interest forms in line with the BTS policy, and copies of forms are available on request from BTS Head Office.

Table 1

Working group membership

The draft document was considered in detail by the BTS SOCC initially in June 2019 and the BTS Quality Improvement Committee in June 2019. The document was made available on the BTS website for public consultation for the period from September to October 2019. Following further revision, the document was submitted for approval to the BTS SOCC in March 2020. The Quality Standards document will be reviewed in 2025, or following the publication of a revised guideline whichever is the sooner. Lay input to the development of the BTS Quality Standards was provided through the lay/patient members of the BTS Standards of Care Committee, which reviewed the document and provided final sign off.

List of Quality statements

References

View Abstract

Footnotes

  • Contributors RC was the lead author responsible for the overall editing and production of the document. All authors were responsible for the final approval of the document.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests All authors completed a Declarations of Interest form in line with the BTS Policy for Declarations of Interest and forms are available on request from BTS Head Office. RC received funding from Actelion and MSD. PA received funding from Chiesi. RA received funding from Daiichi and from BMS, Pfizer and Bayer. RL received funding from Bayer and Actelion. MN received funding from MSD, GSK and Actelion. JS received funding from MSD, Chiesi, GSK, Teva and Johnson and Johnson. EG, LH, SP, WP, DH, LJS and PJ had no interests to declare.

  • Patient and public involvement Patients and/or the public were involved in the design, conduct, reporting or dissemination plans of this research. Refer to the 'Methods' section for further details.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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