Evaluating the Efficiency of a Standardized Pulmonary Embolism Care Pathway Using the YEARS Criteria: A Comparison with Emergency Department Patients

Abstract

Introduction Pulmonary embolism is a common, life-threatening condition with a variety of symptoms, making diagnosis challenging. In the Netherlands, the yearly incidence of pulmonary embolism in primary care is estimated at 1.4 per 1000 patients. Traditionally, CT pulmonary angiography (CTPA) is used for diagnosis, but overusing it can result in unnecessary risks. To address this, and to guide diagnostic management, clinical decision rules were introduced. At the Jeroen Bosch Hospital, these clinical decision rules have been integrated in a new pulmonary embolism care pathway for primary care patients. This retrospective study compared the effectiveness of the care pathway with traditional diagnostic strategies, focusing on the number of CTPA scans performed and physician satisfaction. Methods Data was retrospectively collected from patients presenting at either the pulmonary embolism care pathway, or at the emergency department, between June 2024 and January 2025. Additionally, a satisfaction survey was conducted among general practitioners who had the option to refer patients to the care pathway. Results The study involved a total of 323 patients in the care pathway group and 175 patients in the control group. The prevalence of pulmonary embolism was 6.2% in the care pathway group compared to 11.6% in the control group. Patients referred to the care pathway were less likely to undergo unnecessary CTPA. General practitioners expressed high satisfaction with the care pathway, especially regarding time efficiency and patient-friendliness. Conclusion The pulmonary embolism care pathway improves diagnostic efficiency and reduces unnecessary imaging while maintaining high physician and patient satisfaction. Strictly implementing the YEARS criteria in emergency departments may yield similar results.