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The purpose of this study is to analyze the clinical impact of an educational intervention on adherence to Clinical Practice Guidelines in an Emergency Department (ED), by using a standardized training, for improving diagnostic sensibility and reducing unnecessary scans, adverse effects and stays in the ED.
The Hospital de la Santa Creu i Sant Pau Emergency Department (ED) implemented a training program between May and June 2015 to improve compliance and adherence to recommended clinical practice and optimize the diagnosis and management of patients with suspected Pulmonary Embolism (PE). The training program was standardized, systematic and continuous, with subsequent reinforcement to ensure implementation. This paper aims to evaluate the clinical impact of the training intervention. The establishment of training measures to improve adherence to guidelines implies clinical practice improvement and benefits patients and health system. Moreover, it is a simple and inexpensive intervention, and can be easily reproduced in other ED.
All adult patients (<18 y) with suspected pulmonary embolism attended at Emergency Department will be included. Retrospective information from two different periods (before and after the training intervention) will be collected. First period: 1/1/2012 - 31/12/2012 and second Period: 01.06.2015 - 30/11/2015, pre and post intervention.
OBJECTIVES
A. Primary:
B.- Secondary
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Pre-intervention PE Diagnosis | No Intervention | Patients visited in Emergency Department, with suspected Pulmonary Embolism, before the training intervention. | |
| Post-intervention PE Diagnosis | Experimental | Patients visited in Emergency Department, with suspected Pulmonary Embolism, after the training intervention. Training intervention centered on emergency department staff, regarding the application of clinical probability scores (Wells and Geneva scores) to guide the determination of D-dimer and the performance of pulmonary CT in patients with suspected pulmonary embolism. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Training Intervention for PE Diagnosis | Behavioral | Focused on the Emergency Department staff and the rotating residents during the months 4 and 5 of 2015, and consisted of:
|
| Measure | Description | Time Frame |
|---|---|---|
| Number of cases where clinical guidelines have been followed for suspected Pulmonary Embolism in the Emergency Department (adherence) | October, November, December 2016 | 3 months |
| Number of cases where clinical guidelines have been followed for suspected Pulmonary Embolism in the Emergency Department (adherence) after training measures among staff in Emergency Department | January, February and Mach 2017 | 3 months |
| Measure | Description | Time Frame |
|---|---|---|
| Prevalence of different clinical characteristics of Pulmonary Embolism (presentation, clinical features, treatment, clinical evolution) | 12 months | |
| Prevalence of different clinical characteristics of Pulmonary Embolism related to age (three subgroups of patients with PE: young patients (<50 years), elderly patients (<65 years) and cancer) |
| Measure | Description | Time Frame |
|---|---|---|
| Adherence to clinical guidelines after the implementation of a systematic, standardized, continuous training intervention for improving processes and results. | Number of patients with suspected pulmonary embolism in whom the decision to perform D-Dimer and TC was based on clinical probability scores (Wells and Geneva test) | 12 months |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Mireia Puig, PhD | Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau - IIB Sant Pau | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hospital de la Santa Creu i Sant Pau | Barcelona | 08025 | Spain |
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| ID | Term |
|---|---|
| D011655 | Pulmonary Embolism |
| ID | Term |
|---|---|
| D008171 | Lung Diseases |
| D012140 | Respiratory Tract Diseases |
| D004617 | Embolism |
| D016769 | Embolism and Thrombosis |
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|
| 12 months |
| D-dimmer corrected by age in all cases | 12 months |
| Sensibility and Specificity of new algorithm (Clinical Score+ Dimmer corrected age) in the elderly population group (<65 years) | 12 months |
| D014652 |
| Vascular Diseases |
| D002318 | Cardiovascular Diseases |