Citations 2
Key findings from multisite implementation of electronic health record tools for clinical pretest probability of pulmonary embolism in the emergency department
Houghton, Damon E. , Keenan, Megan , Dykhoff, Hayley J. , Campbell, Kyle N., Hall, Marie Boas, Heaton, Heather A. , Thompson, Kristine M., Aranda, Jamie, Balgord, Sarah , Rubin, Jonathan M. , Hanson, Ryan , He, Wei , Cahill, Emily , Heaton, Heather, Thompson, Kristine, Houghton, Damon E , Hall, Marie, Raja, Ali S , Dutta, Sayon , McEvoy, Dustin , Kreuziger, Lisa Baumann , Rosovsky, Rachel
Vascular Medicine | June 16, 2025 | Volume: 30 | Issue: 3 | Pages: 302-308
Background: The use of validated risk stratification tools for the workup of suspected pulmonary embolism (PE) is a recommendation of the American Society of Hematology and the American College of Emergency Physicians. Methods: We designed and implemented electronic clinical pretest probability (PTP) tools for use in emergency departments (ED). Overall, 38 EDs (tertiary and regional EDs) in the United States were involved across three health systems. PTP use was analyzed between September 12, 2022 and January 11, 2023 in 270,247 ED visits. PTP use was examined in terms of the percentage of visits for which patients underwent computed tomography pulmonary angiography (CTPA). Each site chose the 3-tier Wells’ score for implementation and Site 2 designed a combined Wells’, pulmonary embolism rule-out criteria (PERC), and YEARS score. Results: At Site 3, forced use resulted in documented PTP scores in 49–53% of ordered CTPAs. At Sites 1 and 2, where PTP scores were optional, documented PTP scores occurred in 2–3% and 1–3% of CTPA orders, respectively. At Site 1, the use of PTP increased slightly over the study period, with signs that PE yield on imaging was also increasing (3.4–5.9%). At Site 2, PE yield on imaging was 9–10%, and it remained similar, with similar use of PTP tools over the study period. PE yield (6–8%) on imaging also remained similar throughout the study at Site 3. Conclusions: Guideline-endorsed PTP scores for PE at three independent health systems in the United States did not increase PE yield on imaging. Novel implementation strategies involving interdisciplinary teams are urgently needed.
Sepsis and Shock Response Team: Impact of a Multidisciplinary Approach to Implementing Surviving Sepsis Campaign Guidelines and Surviving the Process
Grek, Ami , Booth, Sandra, Festić, Emir , Shirazi, Ehsan, Thompson, Kristine M., Starbuck, Angela, McRee, Chad, Naessens, James M. , Maniaci, Michael, Thompson, Kristine, Moreno Franco, Pablo, Maniaci, Michael J. , Franco, Pablo Moreno
American Journal of Medical Quality | November 12, 2016 | Volume: 32 | Issue: 5 | Pages: 500-507
The Surviving Sepsis Campaign guidelines are designed to decrease mortality through consistent application of a 7-element bundle. This study evaluated the impact of improvement in bundle adherence using a time-series analysis of compliance with the bundle elements before and after interventions intended to improve the process, while also looking at hospital mortality. This article describes interventions used to improve bundle compliance and hospital mortality in patients admitted through the emergency department with sepsis, severe sepsis, or septic shock. Quality improvement methodology was used to develop high-impact interventions that led to dramatically improved adherence to the Surviving Sepsis Campaign guidelines bundle. Improved performance was associated with a significant decrease in the in-hospital mortality of severe sepsis patients presenting to the emergency department.