Compliance with guidelines for the investigation and management of patients with suspected pulmonary embolism at Christchurch Hospital.

AIMS

(1) To assess the level of compliance of clinicians at Christchurch Hospital with published local guidelines for the diagnostic management of indeterminate lung scans and for the treatment of pulmonary embolism. (2) To evaluate diagnostic outcomes and the methods used to arrive at the diagnosis.

METHODS

Retrospective case analysis of 94 consecutive cases of suspected pulmonary embolism referred for a lung scan after August 1993 and a further 70 consecutive cases referred after August 1995.

RESULTS

Few clinicians followed the recommendations for the further assessment of indeterminate lung scans. Pulmonary angiography was rarely performed and serial femoral ultrasound was never employed. The majority of patients diagnosed with pulmonary embolism did not have a high probability ventilation/perfusion (VQ) scan or a pulmonary angiogram to support the diagnosis. The use of heparin was overcautious and inconsistent. Major divergences from recommendations were observed in over 50% of cases in which heparin was used to treat pulmonary embolism.

CONCLUSIONS

This audit has uncovered a wide diversity of practice in many aspects of the assessment and management of pulmonary embolism and significant deviations from the published guidelines. Underutilisation of objective imaging methods for establishing the diagnosis implies overreliance on clinical impressions, which are known to be unreliable. A review of the guidelines and further educational initiatives are indicated.