Development, Implementation, and Evaluation of a Pediatric Pulmonary Embolism Clinical Pathway and Pulmonary Embolism Response Team.

OBJECTIVES

U.S. multicenter pediatric data from 2001 to 2014 indicate that the prevalence of pediatric pulmonary embolism (PE) is rising, yet it remains rare at individual centers. Evaluation and management vary due to the low frequency of events. And, therefore, we aimed to develop, implement, and evaluate a clinical management pathway and PE response team (PERT) at our center.

DESIGN

Single-center observational implementation study with pre- vs. post-implementation comparisons.

SETTING

Quaternary care pediatric hospital.

PATIENTS: Pediatric patients younger than 21 years old with acute PE who presented for care between January 2005 and August 2022 (pre-implementation) and between September 2022 and August 2024 (post-implementation).

INTERVENTIONS: Implementation of a PE clinical pathway and PERT.

MEASUREMENTS AND MAIN

RESULTS

A PE clinical pathway and PERT were developed by a multidisciplinary team of pharmacists, quality improvement experts, and physicians from six clinical specialties. Electronic medical record tools were created to support the implementation of this pathway and PERT, and research and quality databases were created for ongoing evaluation. PE evaluation was standardized with the implementation of the PE clinical pathway. In the 23 months post-implementation, there have been 33 patients with acute PE (24 low-risk, seven intermediate-risk, and two high-risk PE), which we compared with our pre-pathway experience of 175 episodes. The proportion of patients who had laboratory testing with brain natriuretic peptide and troponin, or underwent echocardiogram during their admission increased, pre-vs.-post-implementation, respectively (50/175 vs. 30/33; p < 0.01; 55/175 vs. 30/33; p < 0.01; and 142/175 vs. 32/33; p < 0.02). The multidisciplinary PERT was successfully activated for seven patients with intermediate- or high-risk PE.

CONCLUSIONS

Implementation of a pediatric PE clinical pathway and PERT improved standardization of PE evaluation and provided rapid multidisciplinary care for intermediate and high-risk PE. Future reports will evaluate both short- and long-term clinical outcomes in these patients.