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Development, Implementation, and Evaluation of a Pediatric Pulmonary Embolism Clinical Pathway and Pulmonary Embolism
Hilary B Whitworth1,2, Kristina M Wagner1,3,4, Catherine M Avitabile2,5
1Division of Hematology, Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
A new clinical pathway and PE response team (PERT) standardized pediatric pulmonary embolism (PE) evaluation. This multidisciplinary approach improved care for high-risk PE patients.
Area of Science:
- Pediatric Pulmonology
- Cardiology
- Critical Care Medicine
Background:
- Pediatric pulmonary embolism (PE) is a rare but increasingly recognized condition.
- Variability in diagnosis and management exists due to low event frequency at individual centers.
- Developing standardized protocols is crucial for effective pediatric PE care.
Purpose of the Study:
- To develop, implement, and evaluate a clinical management pathway and a PE response team (PERT) for pediatric patients.
- To standardize the evaluation and management of acute PE in a pediatric setting.
- To improve the delivery of timely and multidisciplinary care for pediatric PE.
Main Methods:
- A single-center observational implementation study comparing pre- and post-intervention periods.
- Development of a PE clinical pathway and PERT by a multidisciplinary team.
- Utilized electronic medical record tools and quality databases for implementation and evaluation.
Main Results:
- Implementation standardized PE evaluation, with increased use of laboratory testing and echocardiograms post-pathway.
- The PE response team (PERT) was activated for seven patients with intermediate- or high-risk PE.
- Compared to 175 pre-pathway episodes, 33 acute PE cases were managed post-implementation.
Conclusions:
- A pediatric PE clinical pathway and PERT effectively improved the standardization of PE evaluation.
- The implemented pathway and PERT facilitated rapid, multidisciplinary care for intermediate and high-risk pediatric PE.
- Further studies will assess the short- and long-term clinical outcomes of this intervention.
Objectives:
U.S. multicenter pediatric data from 2001 to 2014 indicate that the prevalence of pediatric pulmonary embolism (PE) is rising, yet it remains rare at individual centers. Evaluation and management vary due to the low frequency of events. And, therefore, we aimed to develop, implement, and evaluate a clinical management pathway and PE response team (PERT) at our center.
Design:
Single-center observational implementation study with pre- vs. post-implementation comparisons.
Setting:
Quaternary care pediatric hospital.
Patients:
Pediatric patients younger than 21 years old with acute PE who presented for care between January 2005 and August 2022 (pre-implementation) and between September 2022 and August 2024 (post-implementation).
Interventions:
Implementation of a PE clinical pathway and PERT.
Measurements And Main Results:
A PE clinical pathway and PERT were developed by a multidisciplinary team of pharmacists, quality improvement experts, and physicians from six clinical specialties. Electronic medical record tools were created to support the implementation of this pathway and PERT, and research and quality databases were created for ongoing evaluation. PE evaluation was standardized with the implementation of the PE clinical pathway. In the 23 months post-implementation, there have been 33 patients with acute PE (24 low-risk, seven intermediate-risk, and two high-risk PE), which we compared with our pre-pathway experience of 175 episodes. The proportion of patients who had laboratory testing with brain natriuretic peptide and troponin, or underwent echocardiogram during their admission increased, pre-vs.-post-implementation, respectively (50/175 vs. 30/33; p < 0.01; 55/175 vs. 30/33; p < 0.01; and 142/175 vs. 32/33; p < 0.02). The multidisciplinary PERT was successfully activated for seven patients with intermediate- or high-risk PE.
Conclusions:
Implementation of a pediatric PE clinical pathway and PERT improved standardization of PE evaluation and provided rapid multidisciplinary care for intermediate and high-risk PE. Future reports will evaluate both short- and long-term clinical outcomes in these patients.
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