Federico Germini1,2, Yang Hu3, Sarah Afzal3, Fayad Al-Haimus3, Srikanth A Puttagunta4, Saghar Niaz3, Teresa Chan3, Natasha Clayton3, Shawn Mondoux3,5, Lehana Thabane6,7,8,9,10, Kerstin de Wit6,3. 1. Department of Health Research Methods, Evidence, and Impact, Health Information Research Unit (HIRU), Communication Research Laboratory (CRL), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. germinif@mcmaster.ca. 2. Department of Medicine, McMaster University, Hamilton, ON, Canada. germinif@mcmaster.ca. 3. Department of Medicine, McMaster University, Hamilton, ON, Canada. 4. Department of Radiology, McMaster University, Hamilton, ON, Canada. 5. Department of Emergency Medicine, St Joseph's Healthcare, Hamilton, ON, Canada. 6. Department of Health Research Methods, Evidence, and Impact, Health Information Research Unit (HIRU), Communication Research Laboratory (CRL), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. 7. Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON, Canada. 8. Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada. 9. Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, ON, Canada. 10. Centre for Evaluation of Medicine, St Joseph's Healthcare, Hamilton, ON, Canada.
Abstract
BACKGROUND: Many evidence-based clinical decision tools are available for the diagnosis of pulmonary embolism (PE). However, these clinical decision tools have had suboptimal uptake in the everyday clinical practice in emergency departments (EDs), despite numerous implementation efforts. We aimed to test the feasibility of a multi-faceted intervention to implement an evidence-based PE diagnosis protocol. METHODS: We conducted an interrupted time series study in three EDs in Ontario, Canada. We enrolled consecutive adult patients accessing the ED with suspected PE from January 1, 2018, to February 28, 2020. Components of the intervention were as follows: clinical leadership endorsement, a new pathway for PE testing, physician education, personalized confidential physician feedback, and collection of patient outcome information. The intervention was implemented in November 2019. We identified six criteria for defining the feasibility outcome: successful implementation of the intervention in at least two of the three sites, capturing data on ≥ 80% of all CTPAs ordered in the EDs, timely access to electronic data, rapid manual data extraction with feedback preparation before the end of the month ≥ 80% of the time, and time required for manual data extraction and feedback preparation ≤ 2 days per week in total. RESULTS: The intervention was successfully implemented in two out of three sites. A total of 5094 and 899 patients were tested for PE in the period before and after the intervention, respectively. We captured data from 90% of CTPAs ordered in the EDs, and we accessed the required electronic data. The manual data extraction and individual emergency physician audit and feedback were consistently finalized before the end of each month. The time required for manual data extraction and feedback preparation was ≤ 2 days per week (14 h). CONCLUSIONS: We proved the feasibility of implementing an evidence-based PE diagnosis protocol in two EDs. We were not successful implementing the protocol in the third ED. REGISTRATION: The study was not registered.
BACKGROUND: Many evidence-based clinical decision tools are available for the diagnosis of pulmonary embolism (PE). However, these clinical decision tools have had suboptimal uptake in the everyday clinical practice in emergency departments (EDs), despite numerous implementation efforts. We aimed to test the feasibility of a multi-faceted intervention to implement an evidence-based PE diagnosis protocol. METHODS: We conducted an interrupted time series study in three EDs in Ontario, Canada. We enrolled consecutive adult patients accessing the ED with suspected PE from January 1, 2018, to February 28, 2020. Components of the intervention were as follows: clinical leadership endorsement, a new pathway for PE testing, physician education, personalized confidential physician feedback, and collection of patient outcome information. The intervention was implemented in November 2019. We identified six criteria for defining the feasibility outcome: successful implementation of the intervention in at least two of the three sites, capturing data on ≥ 80% of all CTPAs ordered in the EDs, timely access to electronic data, rapid manual data extraction with feedback preparation before the end of the month ≥ 80% of the time, and time required for manual data extraction and feedback preparation ≤ 2 days per week in total. RESULTS: The intervention was successfully implemented in two out of three sites. A total of 5094 and 899 patients were tested for PE in the period before and after the intervention, respectively. We captured data from 90% of CTPAs ordered in the EDs, and we accessed the required electronic data. The manual data extraction and individual emergency physician audit and feedback were consistently finalized before the end of each month. The time required for manual data extraction and feedback preparation was ≤ 2 days per week (14 h). CONCLUSIONS: We proved the feasibility of implementing an evidence-based PE diagnosis protocol in two EDs. We were not successful implementing the protocol in the third ED. REGISTRATION: The study was not registered.
Authors: Noah Ivers; Gro Jamtvedt; Signe Flottorp; Jane M Young; Jan Odgaard-Jensen; Simon D French; Mary Ann O'Brien; Marit Johansen; Jeremy Grimshaw; Andrew D Oxman Journal: Cochrane Database Syst Rev Date: 2012-06-13
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Authors: Clive Kearon; Kerstin de Wit; Sameer Parpia; Sam Schulman; Marc Afilalo; Andrew Hirsch; Frederick A Spencer; Sangita Sharma; Frédérick D'Aragon; Jean-François Deshaies; Gregoire Le Gal; Alejandro Lazo-Langner; Cynthia Wu; Lisa Rudd-Scott; Shannon M Bates; Jim A Julian Journal: N Engl J Med Date: 2019-11-28 Impact factor: 91.245
Authors: Marc Righini; Josien Van Es; Paul L Den Exter; Pierre-Marie Roy; Franck Verschuren; Alexandre Ghuysen; Olivier T Rutschmann; Olivier Sanchez; Morgan Jaffrelot; Albert Trinh-Duc; Catherine Le Gall; Farès Moustafa; Alessandra Principe; Anja A Van Houten; Marije Ten Wolde; Renée A Douma; Germa Hazelaar; Petra M G Erkens; Klaas W Van Kralingen; Marco J J H Grootenboers; Marc F Durian; Y Whitney Cheung; Guy Meyer; Henri Bounameaux; Menno V Huisman; Pieter W Kamphuisen; Grégoire Le Gal Journal: JAMA Date: 2014-03-19 Impact factor: 56.272