Quality statement 3: Interim therapeutic dose of anticoagulation therapy for suspected pulmonary embolism

Quality statement 3: Interim therapeutic dose of anticoagulation therapy for suspected pulmonary embolism

Quality statement

People with suspected pulmonary embolism are offered an interim therapeutic dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 1 hour from the time of first clinical suspicion.

Rationale

The consequences of missing a diagnosis of pulmonary embolism (PE) are severe and if a PE is left untreated there is a high risk of mortality. Immediate interim treatment with an anticoagulant is recommended if PE is suspected and a confirmatory test is not immediately available.

Quality measure

Structure: Evidence of local arrangements to ensure people with suspected PE are offered an interim therapeutic dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 1 hour from the time of first clinical suspicion.

Process: The proportion of people with suspected PE whose diagnostic investigations take longer than 1 hour from the time of first clinical suspicion who receive an interim therapeutic dose of anticoagulation therapy.

Numerator – the number of people in the denominator who receive an interim therapeutic dose of anticoagulation therapy.

Denominator – the number of people with suspected PE whose diagnostic investigations take longer than 1 hour from the time of first clinical suspicion.

Outcome: Mortality from PE.

What the quality statement means for each audience

Service providers ensure systems are in place for people with suspected PE to be offered an interim therapeutic dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 1 hour from the time of first clinical suspicion.

Healthcare professionals ensure people with suspected PE are offered an interim therapeutic dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 1 hour from the time of first clinical suspicion.

Commissioners ensure they commission services in which people with suspected PE are offered an interim therapeutic dose of anticoagulation therapy if diagnostic investigations are expected to take longer than 1 hour from the time of first clinical suspicion.

People who may have a pulmonary embolism whose test results are expected to take longer than 1 hour from the time the tests are requested by an appropriate healthcare professional are offered a dose of an anticoagulant (a drug that helps to stop blood clots forming or enlarging, and makes it less likely that a blood clot will come loose and travel to the lungs).

Source guidance

NICE guideline CG144 recommendations 1.1.7, 1.1.8, 1.1.9 and 1.1.10 (key priorities for implementation).

Data source

Structure: Local data collection.

Process: Local data collection. Contained within NICE guideline CG144 clinical audit tools (diagnosis of pulmonary embolism), standard 5.

Outcome: Local data collection.

Definitions

Suspected PE

NICE guideline CG144 recommendations 1.1.7 and 1.1.8 describe the features of suspected PE and how to estimate clinical probability (two‑level PE Wells score).

Diagnostic investigations

As outlined in the diagnostic algorithms in NICE guideline CG144 appendix C.

NICE guideline CG144 recommendations 1.1.9 and 1.1.10 recommend immediate diagnostic testing for people with suspected PE according to clinical probability with appropriate use of anticoagulant.

First clinical suspicion

Clinical suspicion of PE by an appropriate healthcare professional in community or hospital settings.