Ambulatory Emergency Care Pathways. Pulmonary Embolism

Transcription

1 Ambulatory Emergency Care Pathways Pulmonary Embolism Effective Date: September 2011

2 Content Summary Ref Title Description 1 Condition Details Identifies pathway details and clinical sign-off 2 Pathway Algorithm Identifies the pathway to follow to identify patients suitable for Ambulatory Care 3 Patient Criteria Criteria for patients appropriate for the pathway 4 Patient Information Identifies Patient Information leaflets for issue to patients regarding their pathway 5 KPIs Identifies how the pathways are measured

3 1. Condition Details Condition Details Summary HRG/ICD-10 Codes Data (Baseline using 2010/11 outturn) DZ09C, DZ09B / I269 Total Patients per Month (Avg) 7.33 Bed Days Utilised per Month (Avg) : P 1: Pat hw ay Det ails Number of Beds Utilised per Month (Avg) 0.73 ay Details Average Length of Stay 4.12 Potential Percentage suitable for ambulatory care 60-90% 1: Pat hw Details Sign Off: Pathway Designed by Clinical Subject Matter Expert Signed Print Pathway Approved by Specialty Lead Signed Print Pathway Authorised by Divisional Director Signed Print

4 2. Pathway Algorithm Patient Presents with: Suspected PE History & Examination (Including basic observations and weight) Investigations Calculate WELLS Score FBC, U&E, LFT, CRP, Clotting, Troponin, ABG, ECG, Chest X-Ray Please note: the APD check box must be ticked when a patient has been put on the AEC Pathway, whether admitted or discharged. Clinical Review Indicates CTPA Required No PE Excluded Consider Alternative Diagnosis Yes Between 20:00 and 08:00 Hrs If a CTPA cannot be done, admit to MAU as a short-stay patient and book CTPA for following morning Prescribe & Administer ENOXAPARIN CTPA CONFIRMS PE No PE Excluded Consider Alternative Diagnosis Yes Red Flags Massive PE on CTPA, Active Bleeding, Not Ambulatory, Heamodynamically Unstable, Trop Positive, SaO2 on Exercise <90%, Unable to self administer/ comply with 3 rd party administration, No Middle Grade or above review Yes ADMIT No Discharge Patient Issue Patient Info (Include Smoking Cessation Advice) Refer to Anti-Coagulation Clinic as per Trust Procedure Dispense Appropriate Medication as per Trust Formulary Letter to GP

5 3. Patient Criteria Red Flags - Exclude the following Patients and Admit: Following a CTPA: Massive PE Active Bleeding Not Ambulatory Heamodynamically Unstable Trop Positive SaO2 on Exercise <90%, Unable to self administer/ comply with 3 rd party administration Clinical Criteria that requires addressing same day for AECP, else Admit / Reconsider Diagnosis: Confirmed not PE

6 4. Patient Information Key points to remember If you take your medication as instructed, it is unlikely that you will have any problems. However you can give your treatment the best chance of success by following these guidelines; Take your medication and go for your blood tests when you are told to. Carry your anticoagulation therapy record booklet with you in case of an emergency. Tell your healthcare team about all other medicines you may be taking including vitamins and other supplements you have bought from health-food shops. Try to take your medicine at the same time each day teatime or in the evening is often a good time. Remember to tell your healthcare team if you think you have taken too much medication, or have missed a dose. If you go for any other treatment, for example, from another doctor or dentist or pharmacist, tell them you are taking an anticoagulant. Do not take any new medicines, including those you can buy over the counter, without checking with your healthcare team first. Keep all medicines in their original containers and safely out of the reach of children. Tell your healthcare team if you are pregnant or are planning to become so. Limit the amount of alcohol you drink to no more than one or two drinks a day and never go on a binge! Don t make big changes to your diet without talking to someone in your healthcare team. Always tell your healthcare team if you are planning any lifestyle change. Avoid activities which could cause you to bruise or cut yourself, for example, contact sports. If you do cut yourself, apply a clean cloth and press on the wound for at least five minutes if possible, raise the limb. If bleeding does not stop, contact your GP immediately. If you injure or cut your lower legs, see your GP or nurse immediately to get the injury treated. Take gentle exercise as much as possible, for example, walking, swimming, cycling. Wear support tights or stockings. Avoid standing for long periods keep moving if you cannot sit. Put your feet up when sitting in a chair your legs should be supported higher than the seat of the chair if possible. Moisturise the skin on your legs daily to keep them supple. Take particular care while brushing your teeth or shaving consider using a soft tooth brush and an electric shaver. Try to avoid insect bites use an inset repellent, especially on your legs. Always wear shoes or slippers and make sure you have got strong gloves on when gardening. Wear a thimble when you sew. Should you require further advice or assistance please telephone for Accident & Emergency at St. Peter s Hospital.

7 5. KPIs KPIs Core KPIs Description Reduction in the number of patients requiring a stay of more than 24 hours (i.e. a 0-Day LoS) Reduction in the Avg number of Bed Days utilised for the condition How it will be measured Baseline (2010/11) At Min % At Max % PAS PAS Reduction in Bed Numbers PAS Other KPIs Scope Governance Scope: Patients entering the AECP Pathway at St. Peter s Hospital Governance: Reports to the Unscheduled Care Programme Board and Divisional Performance Review Meetings Above Min and Max figures are part year effects for 2011/12 based on month of implementation