The BTS quality standards for the Outpatient Management of Pulmonary Embolism

Tuesday, August 18, 2020

Respiratory Futures welcomes Dr Robin Condliffe, chair of the British Thoracic Society (BTS) Quality Standards Working Group, to talk about the latest release, the BTS Quality Standards (QS) for the Outpatient Management of Pulmonary Embolism (PE).

Why do we need quality standards?

Where appropriate, BTS looks to produce quality standards to accompany their guidelines. The purpose of any BTS QS is to provide measurable markers of good practice; to produce standards that will drive improvements in patient care and be challenging, yet achievable. 

The BTS Guideline for the initial outpatient management of PE was published in 2018 and was followed, in 2019, by the National Confidential Enquiry into Patient Outcome and Death: Know the score, reviewing the quality of care provided to patients with pulmonary embolism. The Society felt that it would have been appropriate to produce the QS to further support the implementation of the recommendations of the Guideline and NCEPOD report.

The development of this document follows the standard production process used by the National Institute for Health and Care Excellence (NICE).

Who do you think will be interested in these QS?

The QS are intended to be used by all healthcare professionals involved in the outpatient care and management of patients with PE, commissioners, service providers and patients and carers.

They should enable healthcare professionals to make decisions about a patients’ care which are based on the latest evidence and best practice. In turn, the document will help to ensure appropriate services are commissioned and that patients and carers are aware of the services they should expect.

Who was involved in developing the quality standards

The working group was composed of thirteen people. This was a truly multi-disciplinary group with representation from respiratory medicine, haematology, emergency and intensive care medicine, acute medicine and pharmacy. Lay representation was provided by the BTS Standards of Care Committee. The document also went through a period of public consultation, something which really helped us to ensure the standards were applicable and workable.

Work began on the QS before COVID-19. Do you feel the QS has taken on new significance?

Pulmonary embolism is an important feature of COVID-19 infection (see BTS guidance). The pandemic has forced us all to look differently at how we manage all patients. Outpatient management of conditions which historically necessitated hospital admission has clear benefits to health services in terms of reducing hospital bed use and to individual patients by reducing the need for hospital admission.

There are 6 separate quality statements in our new document:

  1. CT Pulmonary Angiography should be performed within 24 hours of presentation in patients who are managed via an outpatient pathway and do not have contraindications for contrast imaging.
  2. All patients with confirmed acute PE or on an outpatient pathway for suspected acute PE should have their clinical risk assessed including the use of a validated risk score (PESI, s-PESI, Hestia).
  3. Outpatient management should be offered to all patients with suspected or confirmed acute PE who satisfy clinical risk and exclusion criteria.
  4. All patients managed via an outpatient PE pathway should be reviewed by a senior clinical decision-maker prior to going home.
  5. All patients managed via an outpatient PE pathway should receive verbal and written information containing details of potential complications of the disease process, its treatment and a point of contact.
  6. Patients undergoing outpatient management following diagnosis of an acute PE should have an initial review within 7 days of discharge. Subsequent follow-up by a senior clinician with a special interest in PE should take place within a formal pathway.

The statement areas were chosen to reflect that outpatient PE management should involve timely diagnosis and assessment, should be safe and have senior-oversight, should provide patient information and should have robust follow-up.

It is both mine and the group’s hope, that these standards will encourage the implementation and use of a high quality, patient-centred and evidence-based outpatient management pathway in all UK acute hospitals.


Further reading

BTS COVID-19 guidance on VTD

BTS Guideline on the Initial Outpatient Management of PE

BMJ ORR Article