S59 8 year retrospective analysis of the ambulatory pulmonary embolism (PE) pathway – a safe and effective service

Background The suspicion of PE is a common reason for both hospital admission and hospital stays. Being able to prevent admission in low risk PE patients has previously shown to be safe and cost effective with an established ambulatory service running in our hospital since 2010. In this study we describe the findings from an 8 year retrospective analysis of this service, building on a previous 2 year study. Method An 8 year retrospective analysis from June 2010 to January 2018 was carried out using the PE database. Patients with suspected PE referred to the service using acceptance criteria (appendix a). PE risk was then stratified using the PE severity index (PESI) (3). D-dimers were performed in the low and intermediate probability groups. Those with negative d-dimers were discharged, those with high risk or positive d-dimer underwent imaging in the form of CT pulmonary angiography (CTPA) or ventilation-perfusion (VQ) scanning. This was generally a same day service. For a subset of 418 patients (admitted April-December 2017) 30-day mortality was determined. Results 3767 patients were referred to the service. Out of these patients 2651 (70%) were female and 1116 (30%) were male. 1474 (40%) referrals came from general practice, 898 (24%) from bed bureau, 621 (17%) came from the clinical decisions unit and 562 (15%) came from the emergency department. 106 (3%) of referrals came from other sources. 269 (7%) had a confirmed PE out of which 265 (99%) were managed as outpatients. 1438 CTPAs were performed, 226 (18%) were positive. 416 VQ scans were performed, 27 (6%) were positive. 30-day mortality was zero. Conclusions The analysis shows ambulatory PE care to be effective with 99% of those with confirmed PE being managed without admission. This is an improvement of 27% from the previous study. The service is safe with zero 30-day mortality in a recent subgroup. Summarizing, this is the largest ambulatory PE study which demonstrates the effectiveness and safety of an outpatient ambulatory pulmonary embolism (PE) pathway. Similar services such as this should be implemented in other centres. Reference https://www.ncbi.nlm.nih.gov/pubmed/16020800