Outpatient Imaging for Pulmonary Embolism May Only be Suitable for a Minority

Cameron, Allan; Ogilvie, Catherine; Teckchandani, S; McKay, Gerry

doi:10.1258/smj.2011.011285

Cited by 2 publications

(6 citation statements)

References 17 publications

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“…[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Eight studies provided a definition of admission avoidance, [11][12][13][14][15][16][17][18] while 10 studies assessed interventions using specific hospital admission avoidance decision-making criteria for older people in the subacute setting. 14,[19][20][21][22][23][24][25][26][27] One study described an example of admission avoidance criteria and also provided a definition of admission avoidance. 14 Defining avoidable admission for older people in the subacute setting Table 1 presents identified definitions of avoidable admissions.…”

Section: Resultsmentioning

confidence: 99%

“…Studies describing specific hospital admission avoidance decision-making criteria for older people in the subacute setting included two randomized controlled trials, 19,20 one controlled trial, 17 two pre and post studies 21,24 and five cohort studies (three prospective and two retrospective). 22,23,[25][26][27][28][29] Studies were conducted in the United Kingdom, 19,22,25,26 Spain, 25,27 the United States of America 20,23 and Australia 17,21 (Table 3). Interventions included Hospital In the Nursing Home schemes, with studies analysing data of older people residing in a nursing home who had signed up to the scheme.…”

Section: Hospital Admission Avoidance Decision-making Criteria For Olmentioning

confidence: 99%

“…The intervention introduced a new custom-made clinical decision flow chart used by paramedics to determine whether a person should be admitted to hospital. Five studies investigated short-stay acute care centres, 22,24,27 a day hospital acute care service 25 and an outpatients department acute care service, 26 all using predefined hospital admission avoidance decision-making tools.…”

Section: Hospital Admission Avoidance Decision-making Criteria For Olmentioning

confidence: 99%

“…Conditions and common medical scenarios for the older person that were cited in papers for potential admission avoidance were: respiratory infections, including community acquired pneumonia; 17,19,23,27 urinary tract infections and catheter care; 17,19,21,23 dehydration and associated symptoms; 17,19,22,23 falls 19,21,25 and behavioural management. [25][26][27] Three studies focused on specific conditions (chronic obstructive pulmonary disease, community-acquired pneumonia and pulmonary thromboembolism); here, the decision whether to admit or not was based on determination of level of risk. 25,27 Criteria and tools.…”

Section: Hospital Admission Avoidance Decision-making Criteria For Olmentioning

confidence: 99%

“…29 They classified mild and moderate chronic obstructive pulmonary disease to require a change of treatment of inhaled medication and moderate corticosteroids and antibiotics, respectively, and that any escalation on that should be considered severe and the patient should be hospitalized. A study of outpatient imaging for pulmonary embolism to reduce admissions 26 used the Pulmonary Embolism Severity Index to determine the level of risk for pulmonary embolism, with high-risk patients being hospitalized. 30 Likewise, Noval Menendez et al, 27 in their study of the appropriateness of short-stay medical units for people with community acquired pneumonia, used published criteria to inform subsequent action, that is whether the patient can be treated with oral antibiotics in their own home or in a subacute setting or whether they should be hospitalized.…”

Section: Hospital Admission Avoidance Decision-making Criteria For Olmentioning

confidence: 99%

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Determining when a hospital admission of an older person can be avoided in a subacute setting: a systematic review and concept analysis

Huntley

Davies

Jones

et al. 2019

J Health Serv Res Policy

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Objective To conduct a systematic review of the evidence for when a hospital admission for an older person can be avoided in subacute settings. We examined the definition of admission avoidance and the evidence for the factors that are required to avoid admission to hospital in this setting. Methods Using defined PICOD criteria, we conducted searches in three databases (Medline, Embase and Cinahl) from January 2006 to February 2018. References were screened by title and abstract followed by full paper screening by two reviewers. Additional studies were searched from the grey literature, experts in the field and forward and backward referencing. Data were narratively described, and concept analysis was used to investigate the definition of admission avoidance. Results A total of 17 studies were considered eligible for review; eight provided a definition of admission avoidance and 10 described admission avoidance criteria. We identified three factors which play a key role in admission avoidance in the subacute setting: (1) ambulatory care sensitive conditions and common medical scenarios for the older person, which included respiratory infections or pneumonia, urinary tract infections and catheter care, dehydration and associated symptoms, falls and behavioural management, and managing ongoing chronic conditions; (2) criteria/tools, referring to interventions that have used clinical expertise in conjunction with a range of general and geriatric triage tools; in condition-specific interventions, the decision whether to admit or not was based on level of risk determined by defined clinical tools; and (3) personnel and resources, referring to the need for experts to make the initial decision to avoid an admission. Supervision by nurses or physicians was still needed at subacute level, requiring resources such as short-stay beds, intravenous antibiotic treatment or fluids for rehydration and rapid access to laboratory tests. Conclusion The review identified a set of criteria for ambulatory care sensitive conditions and common medical scenarios for the older person that can be treated in the subacute setting with appropriate tools and resources. This information can help commissioners and care providers to take on these important elements and deliver them in a locally designed way.

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Section: Resultsmentioning

confidence: 99%

Section: Hospital Admission Avoidance Decision-making Criteria For Olmentioning

confidence: 99%

Section: Hospital Admission Avoidance Decision-making Criteria For Olmentioning

confidence: 99%

Section: Hospital Admission Avoidance Decision-making Criteria For Olmentioning

confidence: 99%

Section: Hospital Admission Avoidance Decision-making Criteria For Olmentioning

confidence: 99%

See 3 more Smart Citations

Determining when a hospital admission of an older person can be avoided in a subacute setting: a systematic review and concept analysis

Huntley

Davies

Jones

et al. 2019

J Health Serv Res Policy

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Prognostic models in acute pulmonary embolism: a systematic review and meta-analysis

et al. 2016

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ObjectiveTo review the evidence for existing prognostic models in acute pulmonary embolism (PE) and determine how valid and useful they are for predicting patient outcomes.DesignSystematic review and meta-analysis.Data sourcesOVID MEDLINE and EMBASE, and The Cochrane Library from inception to July 2014, and sources of grey literature.Eligibility criteriaStudies aiming at constructing, validating, updating or studying the impact of prognostic models to predict all-cause death, PE-related death or venous thromboembolic events up to a 3-month follow-up in patients with an acute symptomatic PE.Data extractionStudy characteristics and study quality using prognostic criteria. Studies were selected and data extracted by 2 reviewers.Data analysisSummary estimates (95% CI) for proportion of risk groups and event rates within risk groups, and accuracy.ResultsWe included 71 studies (44 298 patients). Among them, 17 were model construction studies specific to PE prognosis. The most validated models were the PE Severity Index (PESI) and its simplified version (sPESI). The overall 30-day mortality rate was 2.3% (1.7% to 2.9%) in the low-risk group and 11.4% (9.9% to 13.1%) in the high-risk group for PESI (9 studies), and 1.5% (0.9% to 2.5%) in the low-risk group and 10.7% (8.8% to12.9%) in the high-risk group for sPESI (11 studies). PESI has proved clinically useful in an impact study. Shifting the cut-off or using novel and updated models specifically developed for normotensive PE improves the ability for identifying patients at lower risk for early death or adverse outcome (0.5–1%) and those at higher risk (up to 20–29% of event rate).ConclusionsWe provide evidence-based information about the validity and utility of the existing prognostic models in acute PE that may be helpful for identifying patients at low risk. Novel models seem attractive for the high-risk normotensive PE but need to be externally validated then be assessed in impact studies.

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Outpatient Imaging for Pulmonary Embolism May Only be Suitable for a Minority

Cited by 2 publications

References 17 publications

Determining when a hospital admission of an older person can be avoided in a subacute setting: a systematic review and concept analysis

Determining when a hospital admission of an older person can be avoided in a subacute setting: a systematic review and concept analysis

Prognostic models in acute pulmonary embolism: a systematic review and meta-analysis

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