Adherence to Clinical Guidelines in the Diagnosis of Pulmonary Embolism in an Emergency Department. Analysis of the Clinical Impact of a Training Intervention (APEED)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 440
- 试验地点
- 2
- 主要终点
- Number of cases where clinical guidelines have been followed for suspected Pulmonary Embolism in the Emergency Department (adherence)
研究概览
简要总结
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.
详细描述
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:
- Analyze adherence to guidelines for the evaluation of suspected PE in the ED.
- Determine the clinical impact of training intervention (change in adherence to guidelines after training measures among staff in Emergency Department)
- Implementation and consolidation of a systematic, standardized, continuous training intervention for improving processes and results.
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Crossover
- 主要目的
- Diagnostic
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Are included
- •those patients who underwent a D-dimmer for suspected PE
- •all those who underwent the diagnosis of PE at discharge
- •those who died from EP.
排除标准
- •Are excluded:
- •all patients who underwent D-dimmer test with a different diagnosis of EP and those who had a chronic EP
研究组 & 干预措施
Pre-intervention PE Diagnosis
Patients visited in Emergency Department, with suspected Pulmonary Embolism, before the training intervention.
Post-intervention PE Diagnosis
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.
干预措施: Training Intervention for PE Diagnosis (Behavioral)
结局指标
主要结局
Number of cases where clinical guidelines have been followed for suspected Pulmonary Embolism in the Emergency Department (adherence)
时间窗: 3 months
October, November, December 2016
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
时间窗: 3 months
January, February and Mach 2017
次要结局
- 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)(12 months)
- Sensibility and Specificity of new algorithm (Clinical Score+ Dimmer corrected age) in the elderly population group (<65 years)(12 months)
- D-dimmer corrected by age in all cases(12 months)
- Prevalence of different clinical characteristics of Pulmonary Embolism (presentation, clinical features, treatment, clinical evolution)(12 months)