Evidence map›Paper›PMID 33390190›Full record

ArticlePilot and feasibility studies2021

Feasibility of a quality improvement project to increase adherence to evidence-based pulmonary embolism diagnosis in the emergency department.

Federico Germini, Yang Hu, Sarah Afzal, Fayad Al-Haimus, Srikanth A Puttagunta, Saghar Niaz, Teresa Chan, Natasha Clayton, Shawn Mondoux, Lehana Thabane and 1 more

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Article in Pilot and feasibility studies, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Federico GerminiDepartment of Health Research Methods, Evidence, and Impact, Health Information Research Unit (HIRU), Communication Research Laboratory (CRL), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada. germinif@mcmaster.ca.ORCID http://orcid.org/0000-0002-0802-3616
Yang HuDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Sarah AfzalDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Fayad Al-HaimusDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Srikanth A PuttaguntaDepartment of Radiology, McMaster University, Hamilton, ON, Canada.
Saghar NiazDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Teresa ChanDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Natasha ClaytonDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Shawn MondouxDepartment of Medicine, McMaster University, Hamilton, ON, Canada.
Lehana ThabaneDepartment of Health Research Methods, Evidence, and Impact, Health Information Research Unit (HIRU), Communication Research Laboratory (CRL), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
Kerstin de WitDepartment of Health Research Methods, Evidence, and Impact, Health Information Research Unit (HIRU), Communication Research Laboratory (CRL), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMany evidence-based clinical decision tools are available for the diagnosis of pulmonary embolism (PE). However, these clinical decision tools have had suboptimal uptake in the everyday clinical practice in emergency departments (EDs), despite numerous implementation efforts. We aimed to test the feasibility of a multi-faceted intervention to implement an evidence-based PE diagnosis protocol.

methodsWe conducted an interrupted time series study in three EDs in Ontario, Canada. We enrolled consecutive adult patients accessing the ED with suspected PE from January 1, 2018, to February 28, 2020. Components of the intervention were as follows: clinical leadership endorsement, a new pathway for PE testing, physician education, personalized confidential physician feedback, and collection of patient outcome information. The intervention was implemented in November 2019. We identified six criteria for defining the feasibility outcome: successful implementation of the intervention in at least two of the three sites, capturing data on ≥ 80% of all CTPAs ordered in the EDs, timely access to electronic data, rapid manual data extraction with feedback preparation before the end of the month ≥ 80% of the time, and time required for manual data extraction and feedback preparation ≤ 2 days per week in total.

resultsThe intervention was successfully implemented in two out of three sites. A total of 5094 and 899 patients were tested for PE in the period before and after the intervention, respectively. We captured data from 90% of CTPAs ordered in the EDs, and we accessed the required electronic data. The manual data extraction and individual emergency physician audit and feedback were consistently finalized before the end of each month. The time required for manual data extraction and feedback preparation was ≤ 2 days per week (14 h).

conclusionsWe proved the feasibility of implementing an evidence-based PE diagnosis protocol in two EDs. We were not successful implementing the protocol in the third ED. REGISTRATION: The study was not registered.

Identifiers

PMID33390190
PMCPMC7779326

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.