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Clinical decision making: diagnosis of pulmonary embolism in emergency departments


The national investigation

We have started an investigation looking at the timely recognition and treatment of suspected pulmonary embolism (PE).

A person suffering from a PE (a clot in the lung) requires urgent treatment to reduce the chance of significant harm or death.

PE can form when clots from the deep veins of the body, mostly originating in the legs, travel through the venous system and become lodged in the lungs.

The diagnostic tool most commonly used to detect PE is a computerised tomography pulmonary angiogram (CTPA). The most common treatment is giving of anticoagulants which can breakdown existing clots and prevent further clots from forming.

Any delay in recognising the symptoms of PE and treatment of the suspicion of PE increases risk that a patient may suffer harm.

Reference event

We started this investigation after analysis of evidence from another HSIB investigation - management of venous thromboembolism risk in patients following thrombolysis for an acute stroke.

Investigation summary

This investigation will:

  • Look at information sharing between different clinical disciplines relating to the factors for recognising PE and how it is presented, to enable clinicians to make decisions in a dynamic and busy environment.
  • Look at access to diagnostic services, including CTPA and thrombosis centres to quickly diagnose PE.
  • Consider other systemic safety issues identified during the investigation.