Quality statement 6 | Patients undergoing outpatient management following diagnosis of an acute PE should have an initial review within 7 days of discharge. Subsequent follow-up by a senior clinician with a special interest in PE should take place within a formal pathway. |
Rationale | Patients managed via an outpatient pathway require assessment within the first 7 days to enable:
Subsequent follow-up by a senior clinician with a special interest in PE after 3–6 months enables an individualised plan for ongoing anticoagulation to be made, based on the presence or absence of provoking factors and risk factors for bleeding. It also provides an opportunity to discuss other factors related to PE. Furthermore, it allows assessment of any ongoing symptoms of breathlessness, with subsequent investigations for the presence of chronic thromboembolic pulmonary hypertension in selected cases. This follow-up will most often be provided by a doctor, but in some instances may be a specialist nurse or an advanced practitioner who fulfils the Royal College of Nursing standards (https://www.rcn.org.uk/professional-development/advanced-practice-standards). |
Quality measure | Structure:
Process:
Numerator 1: The number of patients treated via an outpatient pathway with a new diagnosis of PE that receive an initial follow-up* within the first 7 days of discharge. Denominator 1: The number of patients treated via an outpatient pathway with a new diagnosis of PE. *Initial follow-up can either be via telephone or face to face. Numerator 2: The number of patients treated via an out-patient pathway for an acute PE that are reviewed within 6 months of diagnosis, subsequent to their initial 7 day review, by a clinician with a special interest in PE as part of a formal pathway** Denominator 2: The number of patients treated via an outpatient pathway with a new diagnosis of PE**. **Local pathways may define certain groups of patients who do not require this later review (eg, patients with certain forms of malignancy). In such instances, these groups of patients should be excluded from the numerator and denominator. |
Description of what the quality statement means for each audience | Service providers:
Healthcare professionals:
Commissioners:
People with confirmed new PE:
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Relevant existing indicators/data sources |
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Source references |
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