Discharging Low-risk Pulmonary Embolism from An Emergency Room
Circulation: Cardiovascular Quality and Outcomes
; 15, 2022.
Article
in English
| EMBASE | ID: covidwho-1938118
ABSTRACT
Background and Objectives:
Patients with PE are traditionally admitted on parenteral agents, despite increasing literature that sPESI negative patients can be safely discharged from the ED. Our quality improvement initiative is focused on outpatient treatment for ED-diagnosed pulmonary emboli (OTPE) and our objective is to assess LOS, readmissions and to describe findings of our follow-up phone calls.Methods:
This is an actively enrolling prospective study from 7/2020 at a single site with >500 PE cases per year with a PE Response Team (PERT). All ED PE patients are screened for OTPE. Exclusion criteria include sPESI ≥ 1, ESC high or intermediate, bleeding ≤ 30 days, hemoglobin < 8, platelet < 50,000, pregnancy, prior VTE, concomitant COVID-19, recent major surgery and social factors. Patients identified are discussed with PERT and ED physicians. If agreed upon, patients are discharged on DOAC with follow-up within one week. Patients receive calls on days 3, 7, and 30 from the OTPE team to assess AE relating to the DOAC or PE. LOS metrics are reported as mean with standard deviations, and readmissions are reported as percentages.Results:
Ninety-eight low-risk patients were identified, of which 50 were OTPE-eligible with mean age 44.5 ± 16.9 years of age and 58% female. When comparing OTPE to low-risk admissions, there are no differences in age (p=0.35) and sex (p=0.72). For OTPE, the follow-up calls on day 3, 7, and 30 revealed no patient reported recurrent VTE, major bleeding or death. There was a similar ED provider to disposition LOS (p=0.74). Low-risk admissions had a higher rate of readmission than OTPE (p=0.19).Conclusion:
Our OTPE process does not increase ED provider to disposition LOS, readmissions, or adverse outcomes. Future work will examine financial implications of OTPE and barriers to adoption of the process. As this is actively enrolling quality improvement initiative, we will continue to track postimplementation to optimize our process.
endogenous compound; hemoglobin; adoption; adult; adverse outcome; bleeding; child; conference abstract; coronavirus disease 2019; emergency ward; female; follow up; hospital discharge; hospital readmission; human; human cell; low risk patient; major clinical study; major surgery; male; outcome assessment; outpatient; physician; pregnancy; preschool child; prospective study; pulmonary embolism response team; risk assessment; social aspect; thrombocyte; total quality management
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Prognostic study
Language:
English
Journal:
Circulation: Cardiovascular Quality and Outcomes
Year:
2022
Document Type:
Article
Similar
MEDLINE
...
LILACS
LIS