Quality standard

Quality statement 5: Follow-up for outpatients with low-risk pulmonary embolism

Quality statement

People aged 18 and over having outpatient treatment for suspected or confirmed low-risk pulmonary embolism (PE) have an agreed plan for monitoring and follow‑up. [new 2021]

Rationale

Having clear arrangements for monitoring and follow‑up for outpatients ensures that they receive the same quality of care from secondary care services as inpatients. Patients should have a written plan that makes them aware of signs to look out for and how and when to get help when needed. This will help to ensure that people having outpatient treatment for suspected or confirmed PE act in a timely manner before things worsen. Specialist services with expertise in thrombosis may not be available at all times, so it is important that the plan also includes information about who they can contact if they need advice outside normal service hours.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

a) Evidence of local arrangements to ensure that people aged 18 and over having outpatient treatment for suspected or confirmed low-risk PE have an agreed plan for monitoring and follow‑up.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from service specifications or local protocols.

b) Evidence that information is available for people aged 18 and over having outpatient treatment for suspected or confirmed low-risk PE on symptoms and signs to look out for, and contact information for healthcare professionals they can discuss concerns with.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from information leaflets.

Process

Proportion of people aged 18 and over having outpatient treatment for suspected or confirmed low-risk PE who have an agreed plan for monitoring and follow‑up.

Numerator – the number in the denominator who have an agreed plan for monitoring and follow‑up.

Denominator – the number of people aged 18 and over having outpatient treatment for suspected or confirmed low-risk PE.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

Rates of emergency admissions to hospital for people aged 18 and over having outpatient treatment for low-risk PE.

Data source: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from case records.

What the quality statement means for different audiences

Service providers (such as secondary care services) ensure that healthcare professionals have the time and resources to discuss and agree a plan for monitoring and follow‑up with people having outpatient treatment for suspected or confirmed low-risk PE.

Healthcare professionals (such as specialists, specialist nurses and allied health professionals) discuss and agree a plan for monitoring and follow‑up with people having outpatient treatment for suspected or confirmed low-risk PE. They provide them with written information on symptoms and signs to look out for, direct contact details of a healthcare professional or team with expertise in thrombosis to discuss concerns with, and information about out-of-hours services they can contact when their secondary care healthcare team is not available. They should provide adequate information to enable people to make an informed decision about outpatient management.

Commissioners (such as clinical commissioning groups) ensure that services have the capacity and resources to discuss and agree a plan for monitoring and follow‑up with people having outpatient treatment for suspected or confirmed low-risk PE.

People who are having outpatient treatment for a pulmonary embolism are given written information on signs and symptoms they should look out for and who to contact if they need help or advice, including out-of-hours services.

Definition of terms used in this quality statement

Agreed plan for follow-up

A plan for follow‑up that is agreed with the person having outpatient treatment for suspected or confirmed low-risk PE. They should be given:

  • written information on symptoms and signs to look out for, including the potential complications of thrombosis and of treatment

  • direct contact details of a healthcare professional or team with expertise in thrombosis who can discuss any new symptoms or signs, or other concerns

  • information about out-of-hours services they can contact when their healthcare team is not available.

[NICE's guideline on venous thromboembolic diseases, recommendation 1.2.4]

Equality and diversity considerations

NICE's guideline on venous thromboembolic diseases covers people aged 18 and over as the evidence for the recommendations focused on this age group. This statement applies to people aged 18 and over, but clinical judgement should be used when treating people aged under 18 having outpatient treatment for suspected or confirmed low-risk PE.

Statement 5 highlights that people are given written information on symptoms and signs to look out for, including the potential complications of thrombosis and of treatment. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally appropriate and age appropriate. For people with additional needs related to a disability, impairment or sensory loss, information should also be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.