Society for Acute Medicine response to NCEPOD ‘Know the Score’ report into pulmonary embolism care

By Dr Nick Scriven

On behalf of the Society for Acute Medicine I would like to thank NCEPOD for their tireless work in producing high quality reports of startling clinical relevance. This report is in the same vein as the others and raises questions for clinicians and service design as well as challenging data produced by other organisations.

The data has confirmed the feeling that PE is a frequently life-threatening condition assessed and diagnosed most frequently by the speciality of acute medicine via ambulatory care units (aka same day emergency care). Overall it is striking to find that just over 10% of the people included in this study either died from the problem or needed treatment in intensive care.

In the report 83% of units said they had specific SDEC areas with a further 12% saying they had pathways of care without any specific location. This ties in very much with the NHS Improvement figures for SDEC implementation as outlined in the NHS Long Term Plan but, worryingly, if you dig deeper only 50% of those units were declared as open seven days a week by the clinicians completing the data returns.

This is in stark contrast to the data from NHSI which is largely based on information from non-clinicians and immediately begs the vital question, as yet undefined by anyone, what is ’open’ in the context of SDEC? This issue is again obliquely flagged later in the report when reviewers felt that 10% of patients were treated as inpatients whereas they could have, in all likelihood, been successfully treated via SDEC – with the most common reasons for not doing so being lack of a service or lack of service hours.

Interestingly, when looking at avoidable delays in giving treatment, those treated as an inpatient were twice as likely to have a potentially serious delay in their treatment as opposed to those treated in SDEC. This, I feel, simply reflects the success of SDEC in this area and those inpatient areas are, perhaps, not as in tune with the processes.

Clinicians do not come out of this report in glowing terms as there are inconsistencies and omissions in pathways and treatments that need addressing, from initial assessment and the giving of the first dose of treatment, to delays in scanning and an almost total lack of a routine structure to the reports coming back from those vital tests.

Overall I think this shines a strong light on a total area of practice in a very common condition and raises what might be uncomfortable questions for clinicians but also, with the data around SDEC, does raise the issue of the data integrity being used by NHSI in assessing the implementation of a key part of strategy.

SAM is willing to look at all of this with our clinical partners in emergency medicine and thoracic medicine and call for us all to work together to improve the care we give.