Reducing Hospital Length of Stay for Low Risk Pulmonary Embolism Patients

Pulmonary embolism (PE) is a potentially fatal condition which affects millions of people globally. Traditionally, people diagnosed with a PE are treated in hospital. However, published guidelines from the European Society of Cardiology (ESC) and British Thoracic Society (BTS) suggest that the early discharge and outpatient management of low-risk PE patients is safe and non-inferior to inpatient management. Despite the evidence and the publication of these guidelines, approximately 80% of low-risk PE patients are managed in the hospital. The practice of hospitalising all patients confirmed with a PE leads to prolonged hospital length of stay and poorer patient outcomes. Using the DMAIC (Define, measure, analyse, improve and control) framework for quality improvement (QI), this project examined the contributing factors leading to the prolonged hospital length of stay of low-risk PE patients. Through the use of various QI tools such as process flow maps, stakeholder analysis and fishbone diagrams, the root cause of prolonged hospitalisation was identified. The data collected identified a low prevalence of low-risk PE patients at the project site; however, it did reveal that hospital days could potentially be saved if these patients were managed as per the ESC and BTS guidelines. Furthermore, physician awareness of these guidelines and the use of stratification tools designed to identify low-risk PE patients was not deemed to be sufficient. The lack of a PE management pathway at the QI site was also amongst the problems identified. This QI project plan discusses several feasible options which could be implemented to overcome the identified problems. These options include increasing physician awareness of PE guidelines and PE risk stratification tools via education modalities, in combination with implementing an early discharge pathway for low-risk PE patients.