PT  - JOURNAL ARTICLE
AU  - T. K. Lim
AU  - J. W. Zhang
AU  - Y. G. Goh
TI  - The impact of implementing a modified YEARS algorithm on the diagnosis of pulmonary embolism
AID  - 10.1183/13993003.congress-2019.PA3638
DP  - 2019 Sep 28
TA  - European Respiratory Journal
PG  - PA3638
VI  - 54
IP  - suppl 63
4099  - http://erj.ersjournals.com/content/54/suppl_63/PA3638.short
4100  - http://erj.ersjournals.com/content/54/suppl_63/PA3638.full
SO  - Eur Respir J2019 Sep 28; 54
AB  - A low test threshold for pulmonary embolism(PE) and over reliance on imaging, especially CT pulmonary angiograms(CTPA) is a common behaviour pattern among physicians. Interventions to improve this low threshold for CTPA testing have been mostly ineffective. The innovative Dutch YEARS study reported fewer CTPA examinations in PE diagnosis(van der Hulle et al. Lancet 2017;390:289). However, the YEARS algorithm have not been evaluated in routine clinical practice. Thus, we examined the effects of implementing a pragmatic, modified version of the YEARS algorithm in PE diagnosis.Methods: This is a prospective study of consecutive hospitalized adult patients who underwent CTPA for PE in an acute medicine department. In 2016 we initiated an audit-feedback program to improve the adherence to evidence based guidelines for PE diagnosis and thus, increase the diagnostic rate of PE from CTPA. In 2018 we implemented a modified YEARS protocol.Results: In 2016 the PE detection rate from CTPA was 7.8%. This was associated with more frequent assessment of pre-test risks and D-dimer testing but an insignificant increase in PE diagnosis from CTPA compared with 2015(7%). In 2018, following the introduction of the modified YEARS protocol, this PE diagnosis rate increased to 25%(p<0.05).Conclusions: Physician education and real-time feedback had a small effect in improving adherence to PE diagnostic protocols and reducing CTPA testing. Implementation of the YEARS protocol resulted in further improvements and merits more extensive evaluation in secular practice.FootnotesCite this article as: European Respiratory Journal 2019; 54: Suppl. 63, PA3638.This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).