Quality statement 4All patients managed via an outpatient PE pathway should be reviewed by a senior clinical decision-maker prior to going home.
RationalePatients with either suspected or confirmed acute PE require review by a senior clinical decision-maker prior to discharge home to ensure that they are suitable for outpatient management and that other potential causes for symptoms have been excluded.
Quality measureStructure:
  • Evidence of local arrangements to ensure that patients managed via an outpatient pathway are reviewed by a senior clinical decision-maker with access to an on-call consultant.


Process:
  • The proportion of patients with suspected or diagnosed acute PE managed via an outpatient pathway who are reviewed by a senior clinical decision-maker prior to going home.


Numerator 1:The number of patients with suspected or confirmed acute PE who are reviewed by a senior clinical decision-maker prior to going home via an outpatient pathway.
Denominator 1:The number of patients with suspected or confirmed acute PE managed via an outpatient pathway.
Description of what the quality statement means for each audienceService providers:
  • Should ensure there are adequate systems, staffing and support services in place to provide outpatient management pathways for eligible patients with suspected or confirmed acute PE.


Healthcare professionals:
  • Should ensure that all patients with suspected or confirmed acute PE who are eligible for management within an outpatient pathway are reviewed by a senior clinical decision-maker prior to going home.


Commissioners:
  • Should ensure that they commission services with sufficient capacity, staff and consultant oversight in order to deliver safe outpatient pathways for the management of suspected and confirmed acute PE.


People who are managed on an outpatient pathway for suspected or confirmed PE:
  • Should receive a review by an appropriate senior clinical decision-maker prior to going home.

Relevant existing indicators/data sources
  • BTS Guideline for the Initial Outpatient Management of Pulmonary Embolism (2018).2

  • Royal College of Physicians of Edinburgh and Society of Acute Medicine. Standards for Ambulatory Emergency Care (2019).5

Source references
  • BTS Guideline for the Initial Outpatient Management of Pulmonary Embolism (2018).2

DefinitionsSenior clinical decision maker: a consultant physician, or if no consultant is available, a senior trainee (ST3 or above, ST4 in the case of emergency medicine), a staff grade or similar substantive career grade doctor or an advanced nurse practitioner or clinical nurse specialist with sufficient experience and training to be designated to undertake this role under an appropriately trained supervisor.
Other informationExample of patient information leaflets—see Appendix 4: King’s College Hospital NHS Foundation Trust, Royal Free London NHS Foundation Trust and Sheffield Teaching Hospitals NHS Foundation Trust.