Increasing Safe Outpatient Management of Emergency Department Patients With Pulmonary Embolism

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Abstract
Many low-risk patients with acute pulmonary embolism (PE) in the emergency department (ED) are eligible for outpatient care but are hospitalized nonetheless. One impediment to home discharge is the difficulty of identifying which patients can safely forgo hospitalization. To evaluate the effect of an integrated electronic clinical decision support system (CDSS) to facilitate risk stratification and decision making at the site of care for patients with acute PE. Controlled pragmatic trial. (ClinicalTrials.gov: NCT03601676) All 21 community EDs of an integrated health care delivery system (Kaiser Permanente Northern California). Adult ED patients with acute PE. Ten intervention sites selected by convenience received a multidimensional technology and education intervention at month 9 of a 16-month study period (January 2014 to April 2015); the remaining 11 sites served as concurrent controls. The primary outcome was discharge to home from either the ED or a short-term (P = 0.007). No increases were seen in 5-day return visits related to PE or in 30-day major adverse outcomes associated with CDSS implementation. Lack of random allocation. Implementation and structured promotion of a CDSS to aid physicians in site-of-care decision making for ED patients with acute PE safely increased outpatient management. Garfield Memorial National Research Fund and The Permanente Medical Group Delivery Science and Physician Researcher Programs.

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