Timing of Discharge Follow-up for Acute Pulmonary Embolism: Retrospective Cohort Study
Introduction: Historically, emergency department (ED) patients with pulmonary embolism (PE) have been admitted for several days of inpatient care. Growing evidence suggests that selected ED patients with PE can be safely discharged home after a short length of stay. However, the optimal timing of fo...
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2015-01-01
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| Series: | Western Journal of Emergency Medicine |
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| Online Access: | http://escholarship.org/uc/item/76b8h8tw |
| _version_ | 1818217305338806272 |
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| author | Vinson, David R. Ballard, Dustin W. Huang, Jie Rauchwerger, Adina S. Reed, Mary E. Mark, Dustin G. |
| author_facet | Vinson, David R. Ballard, Dustin W. Huang, Jie Rauchwerger, Adina S. Reed, Mary E. Mark, Dustin G. |
| author_sort | Vinson, David R. |
| collection | DOAJ |
| description | Introduction: Historically, emergency department (ED) patients with pulmonary embolism (PE) have been admitted for several days of inpatient care. Growing evidence suggests that selected ED patients with PE can be safely discharged home after a short length of stay. However, the optimal timing of follow up is unknown. We hypothesized that higher-risk patients with short length of stay (<24 hours from ED registration) would more commonly receive expedited follow up (≤3 days).
Methods: This retrospective cohort study included adults treated for acute PE in six community EDs. We ascertained the PE Severity Index risk class (for 30-day mortality), facility length of stay, the first follow-up clinician encounter, unscheduled return ED visits ≤3 days, 5-day PE-related readmissions, and 30-day all-cause mortality. Stratifying by risk class, we used multivariable analysis to examine age- and sex-adjusted associations between length of stay and expedited follow up.
Results: The mean age of our 175 patients was 63.2 (±16.8) years. Overall, 93.1% (n=163) of our cohort received follow up within one week of discharge. Fifty-six patients (32.0%) were sent home within 24 hours and 100 (57.1%) received expedited follow up, often by telephone (67/100). The short and longer length-of-stay groups were comparable in age and sex, but differed in rates of low-risk status (63% vs 37%; p<0.01) and expedited follow up (70% vs 51%; p=0.03). After adjustment, we found that short length of stay was independently associated with expedited follow up in higher-risk patients (adjusted odds ratio [aOR] 3.5; 95% CI [1.0-11.8]; p=0.04), but not in low-risk patients (aOR 2.2; 95% CI [0.8-5.7]; p=0.11). Adverse outcomes were uncommon (<2%) and were not significantly different between the two length-of-stay groups.
Conclusion: Higher-risk patients with acute PE and short length of stay more commonly received expedited follow up in our community setting than other groups of patients. These practice patterns are associated with low rates of 30-day adverse events. [West J Emerg Med. 2015;16(1):55–61.] |
| first_indexed | 2024-12-12T07:05:45Z |
| format | Article |
| id | doaj.art-a05225a545c3430d8c7b356ccb92ff01 |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-12-12T07:05:45Z |
| publishDate | 2015-01-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-a05225a545c3430d8c7b356ccb92ff012022-12-22T00:33:44ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182015-01-01161556110.5811/westjem.2014.12.23310Timing of Discharge Follow-up for Acute Pulmonary Embolism: Retrospective Cohort StudyVinson, David R.0Ballard, Dustin W.1Huang, Jie2Rauchwerger, Adina S.3Reed, Mary E.4Mark, Dustin G.5The Permanente Medical Group, Oakland, California; Kaiser Permanente Roseville Medical Center, Roseville, California;Kaiser Permanente Division of Research, Oakland, CaliforniaThe Permanente Medical Group, Oakland, California;Kaiser Permanente Division of Research, Oakland, California; Kaiser Permanente San Rafael Medical Center, San Rafael, CaliforniaKaiser Permanente Division of Research, Oakland, CaliforniaKaiser Permanente Division of Research, Oakland, CaliforniaKaiser Permanente Roseville Medical Center, Roseville, CaliforniaThe Permanente Medical Group, Oakland, California; Kaiser Permanente Oakland Medical Center, Oakland, CaliforniaIntroduction: Historically, emergency department (ED) patients with pulmonary embolism (PE) have been admitted for several days of inpatient care. Growing evidence suggests that selected ED patients with PE can be safely discharged home after a short length of stay. However, the optimal timing of follow up is unknown. We hypothesized that higher-risk patients with short length of stay (<24 hours from ED registration) would more commonly receive expedited follow up (≤3 days). Methods: This retrospective cohort study included adults treated for acute PE in six community EDs. We ascertained the PE Severity Index risk class (for 30-day mortality), facility length of stay, the first follow-up clinician encounter, unscheduled return ED visits ≤3 days, 5-day PE-related readmissions, and 30-day all-cause mortality. Stratifying by risk class, we used multivariable analysis to examine age- and sex-adjusted associations between length of stay and expedited follow up. Results: The mean age of our 175 patients was 63.2 (±16.8) years. Overall, 93.1% (n=163) of our cohort received follow up within one week of discharge. Fifty-six patients (32.0%) were sent home within 24 hours and 100 (57.1%) received expedited follow up, often by telephone (67/100). The short and longer length-of-stay groups were comparable in age and sex, but differed in rates of low-risk status (63% vs 37%; p<0.01) and expedited follow up (70% vs 51%; p=0.03). After adjustment, we found that short length of stay was independently associated with expedited follow up in higher-risk patients (adjusted odds ratio [aOR] 3.5; 95% CI [1.0-11.8]; p=0.04), but not in low-risk patients (aOR 2.2; 95% CI [0.8-5.7]; p=0.11). Adverse outcomes were uncommon (<2%) and were not significantly different between the two length-of-stay groups. Conclusion: Higher-risk patients with acute PE and short length of stay more commonly received expedited follow up in our community setting than other groups of patients. These practice patterns are associated with low rates of 30-day adverse events. [West J Emerg Med. 2015;16(1):55–61.]http://escholarship.org/uc/item/76b8h8twTiming of DischargeAcute Pulmonary Embolism |
| spellingShingle | Vinson, David R. Ballard, Dustin W. Huang, Jie Rauchwerger, Adina S. Reed, Mary E. Mark, Dustin G. Timing of Discharge Follow-up for Acute Pulmonary Embolism: Retrospective Cohort Study Western Journal of Emergency Medicine Timing of Discharge Acute Pulmonary Embolism |
| title | Timing of Discharge Follow-up for Acute Pulmonary Embolism: Retrospective Cohort Study |
| title_full | Timing of Discharge Follow-up for Acute Pulmonary Embolism: Retrospective Cohort Study |
| title_fullStr | Timing of Discharge Follow-up for Acute Pulmonary Embolism: Retrospective Cohort Study |
| title_full_unstemmed | Timing of Discharge Follow-up for Acute Pulmonary Embolism: Retrospective Cohort Study |
| title_short | Timing of Discharge Follow-up for Acute Pulmonary Embolism: Retrospective Cohort Study |
| title_sort | timing of discharge follow up for acute pulmonary embolism retrospective cohort study |
| topic | Timing of Discharge Acute Pulmonary Embolism |
| url | http://escholarship.org/uc/item/76b8h8tw |
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