(376) Implementation of a PE Pathway Increases Definitive Treatment and Decreases Hospital Length of Stay

Introduction: The rapid evolution of best practice standards for pulmonary embolism (PE) makes it challenging to standardize care across teams and hospitals. Our large health system implemented a "Care Signature" PE pathway integrated in the electronic health record (EHR) to standardize diagnostic and therapeutic interventions directly from the pathway, including risk stratification, criteria for PE Response Team (PERT) activation, indications for thrombolysis and catheter-directed therapy, and guidance for transition to enteral therapy. We sought to determine if pathway utilization improved delivery of catheter-directed therapy (CDT) and hospital length of stay (HLOS).

Methods: A multidisciplinary group representing ICUs, ED, Pulmonary, Nursing, Pharmacists, Cardiology, and Interventional Radiology in our health system was convened to create a PE pathway. The group met regularly over several weeks to review existing literature and guidelines, internal metrics, national data, map clinical steps, and draft consensus statements for areas of variable clinical practice. The consensus statements were harnessed to create a PE pathway that went live on October 1, 2021. Retrospective review of consecutive patients diagnosed with PE between October 1, 2021 and March 31, 2023 was conducted using the StrataJazz database. Primary outcomes were the proportion of patients receiving CDT and HLOS. Independent Samples t-Test, was used to compare the use of CDT and HLOS between those patients who had the pathway utilized and those who did not.

Results: Patients in whom the pathway was utilized were more likely to receive CDT (OR, 5.1; 95% CI, 3.1-8.3, p< 0.0001). Pathway patients also had a 1.5-day reduction in HLOS (95% CI -2.7 to -0.2, p=0.02). There was no statistical difference in ICU LOS, case mix index, or mortality. The reduction in HLOS for pathway patients translates to an annual cost avoidance of $189,000.

Conclusions: PE patients in whom the Care Signature pathway was utilized were more likely to receive definitive treatment and have a shorter HLOS compared to those in whom the pathway was not utilized. Further studies are needed to determine the impact of pathways on additional patient outcomes.