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PP42 Call assessor-initiated referral without clinical discussion to medical SDEC (same day emergency care): a new pathway for suspected pulmonary embolism
  1. Josh Miller1,
  2. Emma Williams1,
  3. Scott Harris1,
  4. Samuel Goodman1,
  5. Richard Topping1,
  6. Paul Musticone1,
  7. Paula Dodgson2
  1. 1West Midlands Ambulance Service University NHS Foundation Trust, Brierley Hill, UK
  2. 2University Hospitals Coventry and Warwickshire NHS Trust


Background Same day emergency care (SDEC) aims to rapidly assess, diagnose and treat patients with relevant conditions without admitting them to hospital. Reducing clinical touchpoints during the referral to SDEC may reduce operational burden and improve patient experience. In June 2022, an English ambulance trust implemented a new pathway for call assessors reaching a specific NHS Pathways outcome of adults with suspected pulmonary embolism to refer directly to medical SDEC.

Methods We identified all call-assessor-handled 999 and 111 cases with a final outcome of NHS Pathways suspected pulmonary embolism during the period 1st June 2021 to 31st January 2023 for a single hospital. We reported whether the call assessor involved a clinician, and the receiving service, before and after the new pathway introduction. For the period 1st June 2022 to 1st September 2022 we reviewed attendance and diagnosis outcome for patients at the relevant SDEC.

Results Before the new pathway, 1st June 2021-31st May 2022, 233 patients with suspected pulmonary embolism were signposted to attend the relevant Emergency Department (ED), and none to SDEC. Since the new pathway, 1st June 2022-31st January 2023, 171 were signposted to ED, and 116 to SDEC. Of the latter, 9/116 (8%) involved a clinician discussion.

For the period where SDEC attendance and outcome data were available, 11/33 (33%) of patients did not attend, 5 (15%) did not wait, 5 (15%) had a respiratory infection, 5 (15%) a musculoskeletal condition, 3 (9%) exacerbation of long-term illness, 2 (6%) other conditions, and 2 (6%) were unknown. One of the 33 was admitted. None had pulmonary embolism.

Conclusion Call assessors using a pathway for suspected pulmonary embolism may benefit providers and patients. Most patients signposted on this pathway were treated under same-day care. Further study could investigate those patients who did not attend or wait for assessment.

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