A pulmonary embolism is a blood clot that blocks and stops blood flow to an artery in the lung. In most cases, the blood clot starts in a deep vein in the leg and travels to the lung. Rarely, the clot forms in a vein in another part of the body. When a blood clot forms in one or more of the deep veins in the body, it's called a deep vein thrombosis (DVT). Because one or more clots block blood flow to the lungs, pulmonary embolism can be life-threatening. However, prompt treatment greatly reduces the risk of death. Taking measures to prevent blood clots in your legs will help protect you against pulmonary embolism. The design and implementation of CDS tools should not only include careful consideration of their content and purpose, but their method of monitoring for success in terms of outcomes, functionality, and how they fit in the context of other CDS tools that are currently in place (see Section 5 for further details). However, formalized support and regulation for CDS is not abundantly common. In 2018, the US Food and Drug Administration offered a draft set of recommendations for CDS software (Food and Drug Administration 2018). Although not enacted into law, this type of oversight only proposes to cover certain types of CDS, but it is not yet fully defined what it would cover. Organizations such as the Health Information and Management Systems Society (HIMSS) and the American Medical Informatics Association (AMIA) have made comments on this draft, making apparent the need for further clarification by the FDA on what types of CDS will be effected. Due to a lack of current formalized regulation, CDS developers and implementers must be conscientious in assuring these tools are in fact functioning as intended and not unintentionally causing patient harm. Referring to the 5 rights and GUIDE checklist may be helpful.

1. CDS TOOL FOR PULMONARY EMBOLISM
Group-6
Savitha Sagar Balguri
Naga Venkata Bala Sri Harsha Kandregula
Parimala Sareddy
Department of Healthcare Informatics - Sacred Heart University
Evidence base practice and clinical decision support HINF-552-AOS
Professor-Robert Corry
Course project due- 11/15/2023

2. Agenda
Introduction
Rationale for QPS
goal
Literatre review
Existing CDS tool
description
CDS tool evaluation Design proposal conclsion

3. Introduction to pulmonary embolism
Pulmonary embolism (PE) is a critical medical condition characterized by the sudden blockage
of one or more arteries in the lungs, usually caused by blood clots that have travelled from other
parts of the body, most commonly from the deep veins of the legs (deep vein thrombosis or
DVT). PE is a life-threatening emergency, and its symptoms can range from mild to severe,
including shortness of breath, chest pain, and rapid heart rate, in severe cases, it can lead to
cardiac arrest or death if not promptly diagnosed and treated.
QPS goal
To introduce a CDS tool to reduce the risk of pulmonary embolism
https://doi.org/10.1186/s13063-015-1049-7

4. The rationale for QPS goal
Current Scenario
• PE poses a significant health risk, requiring proactive strategies for prevention and early detection.
• Varied risk assessment methods may lead to inconsistent outcomes and delays in intervention.
CDS tool
• Efficiency: Streamlines risk assessment for swift and accurate evaluations.
• Consistency: Standardizes risk assessment with the Pulmonary Embolism Rule-Out Criteria (PERC) model.
• Real-time Integration: Seamlessly integrates with Electronic Health Records (EHRs) for instant access to
patient data.
Expected Benefits
• Improved Risk Stratification: Identifies varying risk levels for targeted interventions.
• Clinical Decision Support Alerts: Provides real-time guidance for adherence to best practices.
• Documentation: Enhances EHR records for comprehensive and accountable care.
Alignment with QPS Goal
• Fulfills the goal of implementing evidence-based tools for better patient outcomes.
https://doi.org/10.1186/s13017-016-0078-1

5. Literature Review
Search Strategy:
• Utilized reputable databases: PubMed, ScienceDirect, Google Scholar, and Embase.
• Keywords: "pulmonary embolism," "clinical decision support system," "CDSS tool," "diagnosis," "management,"
"treatment."
• MeSH terms: "Pulmonary Embolism," "Decision Support Systems, Clinical," "Diagnosis," "Therapeutics," "Deep
Vein Thrombosis."
Inclusion Criteria:
• Studies published within the last 10 years for up-to-date information.
• Systematic reviews, randomized controlled trials, observational studies, and case reports.
• Involvement of adult patients (18 years and older) for relevance.
• Studies presenting validated risk assessment tools for pulmonary embolism.
Exclusion Criteria:
• Excluded pediatric patients, Studies investigating interventions not directly related to pulmonary embolism and
studies with significant conflicts of interest introduce bias.
• Investigated the usability and acceptance of CDSS tools by healthcare professionals. Explored existing risk
assessment tools (e.g., Wells score, Geneva score) for pulmonary embolism.
• Searched for information on monitoring patients with pulmonary embolism, including follow-up protocols and safety
considerations.
https://doi.org/10.2196/preprints.32230

6. CDS TOOL DESCRIPTION
AIM AND DESCRIPTION
The Wells Criteria and PERC Rule are clinical decision tools used in the assessment of patients with
suspected deep vein thrombosis (DVT) and pulmonary embolism (PE). These tools help healthcare
professionals determine the probability of these conditions and guide the need for further diagnostic testing.
The Wells Criteria aim to estimate the pretest probability of deep vein thrombosis (DVT) or pulmonary
embolism (PE) in a patient and the PERC Rule is designed to identify patients with a low clinical probability
of pulmonary embolism (PE) who may not need further diagnostic testing.

7. CDS TOOL EVALUATION
Benefits of the PERC (Pulmonary Embolism Rule-Out Criteria) Model
1. Rapid Triage: The PERC model allows quick assessment of patients with suspected pulmonary
embolism, facilitating efficient identification of low-risk individuals.
2. Reduction in Unnecessary Testing: By using the PERC model, unnecessary diagnostic tests like
CTPA and D-dimer testing can be minimized for low-risk patients, leading to lower radiation
exposure and healthcare costs.
3. Streamlined Clinical Decision Support: The PERC model offers a standardized approach for
healthcare providers, improving consistency in clinical assessments and providing clear criteria for
decision-making.

8. POTENTIAL FLAWS OF THE PERC MODEL
Limited Risk Stratification: The PERC model focuses on ruling out low-risk patients and doesn't offer risk
assessment for those with moderate or high pretest probability.
Exclusion Principle: Operating on an exclusion principle, the PERC model recommends further testing if any of
its eight criteria are positive, potentially leading to over-testing in situations where clinical judgment indicates
low risk.
Limited Sensitivity: While highly specific, the PERC model is less sensitive, excelling in ruling out low-risk
cases but may miss some instances of pulmonary embolism. It should be supplemented by clinical judgment
and not used in isolation for all patients.
https://doi.org/10.7326/0003-4819-135-2-200107170-00005

9. SUGGESTIONS TO IMPROVE THE PERC MODEL
1. Enhanced Risk Stratification: Integrating additional risk assessment tools with the PERC model in the Clinical
Decision Support (CDS) system for more comprehensive patient risk stratification, especially for moderate and high-
risk cases.
2. Real-time EHR Integration: Implement real-time integration of the PERC model into Electronic Health Records
(EHRs) for automatic calculation and display of PERC scores during patient assessments, aiding healthcare
providers in decision-making.
3. Clinical Decision Support Alerts: Incorporate real-time clinical decision support alerts in the CDS system based
on PERC scores, providing healthcare providers with timely reminders and recommendations to ensure adherence to
best practices and guidelines.

10. Standard strategy for the diagnosis
of pulmonary embolism (PE) in the
Emergency Department (ED)
Work-up for diagnosis of pulmonary
embolism (PE)
CDS TOOL DIAGRAM

11. CONCLUSION
In conclusion, enhancing the Clinical Decision Support (CDS) tool with the PERC
(Pulmonary Embolism Rule-Out Criteria) model for pulmonary embolism evaluation offers
a valuable approach for risk reduction. Integrating additional risk stratification tools,
enabling real-time Electronic Health Record integration, and incorporating decision support
alerts can further refine this system, ensuring more comprehensive assessments and timely
interventions. These improvements aim to strengthen clinical decision-making, optimize
patient care, and contribute to a well-documented and effective strategy for reducing the
risk of pulmonary embolism in healthcare settings.

12. References
Modi, S., Deisler, R., Gozel, K., Reicks, P., Irwin, E., Brunsvold, M., Banton, K.,
& Beilman, G. J. (2016). Wells criteria for DVT is a reliable clinical
tool to assess the risk of deep venous thrombosis in trauma patients.
World Journal of Emergency Surgery, 11(1).
https://doi.org/10.1186/s13017-016-0078-1
Zhang, N. J., Rameau, P., Julemis, M., Liu, Y., Solomon, J., Khan, S., McGinn,
T., & Richardson, S. (2021). Automated Pulmonary Embolism Risk
Assessment Using the Wells Criteria: Validation Study (Preprint).
https://doi.org/10.2196/preprints.32230
Simon, M. A., Tan, C., Hilden, P., Gesner, L., & Julius, B. (2021). Effectiveness
of clinical decision tools in predicting pulmonary embolism.
Pulmonary Medicine, 2021, 1–5. https://doi.org/10.1155/2021/8880893
Improving the diagnosis of pulmonary embolism in the emergency department.
(2001). Annals of Internal Medicine, 135(2).
https://doi.org/10.7326/0003-4819-135-2-200107170-00005
Freund, Y., Rousseau, A., Guyot-Rousseau, F., Claessens, Y.-E., Hugli, O.,
Sanchez, O., Simon, T., & Riou, B. (2015). Perc rule to exclude the
diagnosis of pulmonary embolism in emergency low-risk patients: Study
protocol for the proper randomized controlled study. Trials, 16(1).
https://doi.org/10.1186/s13063-015-1049-7

13. Thank you