Dataset Information

Safety, efficacy, length of stay and patient satisfaction with outpatient management of low-risk pulmonary embolism patients - a meta-analysis.

ABSTRACT:

Introduction

Annual health expense of hospital admissions, due to venous thromboembolism including pulmonary embolism, exceeds 10 billion dollars in the United States. Most of these patients still get admitted to the hospital despite the advent of novel oral anticoagulants. Our aim is to show that low-risk pulmonary embolism patients can safely be discharged from the emergency department with similar patient satisfaction and lower length of stay.

Methods

A comprehensive search in Medline indexed and non-indexed, Embase, and Cochrane Central was performed to search for all the randomized controlled trials that compared inpatient treatment of low-risk pulmonary embolism to outpatient treatment.

Results

Of 68 potentially relevant studies, a total of 2 studies (453 participants) met our inclusion criteria and had data available on patient satisfaction, length of stay, efficacy, and patient safety. The pooled estimate of the included studies showed that at 3-month follow-up, there was no statistically significant difference between inpatient and outpatient treatment of these low-risk patients.

Conclusions

In conclusion, our meta-analysis of 2 randomized controlled trials shows that low-risk pulmonary embolism patients can safely be discharged from the emergency departments in the limited studies available. We need more randomized controlled trials to confirm these findings.

SUBMITTER: Malik AH

PROVIDER: S-EPMC7811300 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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Publications

Safety, efficacy, length of stay and patient satisfaction with outpatient management of low-risk pulmonary embolism patients - a meta-analysis.

Malik Aaqib H AH Aronow Wilbert S WS

Archives of medical science : AMS 20210105 1

<h4>Introduction</h4>Annual health expense of hospital admissions, due to venous thromboembolism including pulmonary embolism, exceeds 10 billion dollars in the United States. Most of these patients still get admitted to the hospital despite the advent of novel oral anticoagulants. Our aim is to show that low-risk pulmonary embolism patients can safely be discharged from the emergency department with similar patient satisfaction and lower length of stay.<h4>Methods</h4>A comprehensive search in ...[more]

PMID: 33488878

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Project description:IntroductionMany emergency department (ED) patients with acute pulmonary embolism (PE) who meet low-risk criteria may be eligible for a short length of stay (LOS) (<24 hours), with expedited discharge home either directly from the ED or after a brief observation or hospitalization. We describe the association between expedited discharge and site of discharge on care satisfaction and quality of life (QOL) among patients with low-risk PE (PE Severity Index [PESI] Classes I-III).MethodsThis phone survey was conducted from September 2014 through April 2015 as part of a retrospective cohort study across 21 community EDs in Northern California. We surveyed low-risk patients with acute PE, treated predominantly with enoxaparin bridging and warfarin. All eligible patients were called 2-8 weeks after their index ED visit. PE-specific, patient-satisfaction questions addressed overall care, discharge instruction clarity, and LOS. We scored physical and mental QOL using a modified version of the validated Short Form Health Survey. Satisfaction and QOL were compared by LOS. For those with expedited discharge, we compared responses by site of discharge: ED vs. hospital, which included ED-based observation units. We used chi-square and Wilcoxon rank-sum tests as indicated.ResultsSurvey response rate was 82.3% (424 of 515 eligible patients). Median age of respondents was 64 years; 47.4% were male. Of the 145 patients (34.2%) with a LOS<24 hours, 65 (44.8%) were discharged home from the ED. Of all patients, 89.6% were satisfied with their overall care and 94.1% found instructions clear. Sixty-six percent were satisfied with their LOS, whereas 17.5% would have preferred a shorter LOS and 16.5% a longer LOS. There were no significant differences in satisfaction between patients with LOS<24 hours vs. ≥24 hours (p>0.13 for all). Physical QOL scores were significantly higher for expedited-discharge patients (p=0.01). Patients with expedited discharge home from the ED vs. the hospital had no significant difference in satisfaction (p>0.20 for all) or QOL (p>0.19 for all).ConclusionED patients with low-risk PE reported high satisfaction with their care in follow-up surveys. Expedited discharge (<24 hours) and site of discharge were not associated with differences in patient satisfaction.

Project description:BackgroundMost patients with pulmonary embolism (PE) spend 5-7 days in hospital even though only 4.5% will develop serious complications during this time. In particular, the group of patients with incidentally diagnosed PE (i-PE) includes many patients with low risk features potentially ideal for outpatient management; however the evidence for their optimal management is lacking hence relative practices may vary considerably. We describe the development process, components, links and function of a nurse-led service for the management of patients with i-PE, developed in accordance to the UK Medical Research Council complex intervention guidance.MethodsPhase 0 (Theoretical underpinning): The Pulmonary Embolism Severity Index (PESI) was selected for patient risk assessment and the American Society of Clinical Oncology (ASCO) guideline for the management of PE in cancer patients (2007) was selected as quality measure. Historical registry and audit data from our centre regarding i-PE incidence and management for the period between 2006 and 2009 illustrating the then current practices were reviewed. Phase 1 (Modelling): Modelling of the pathway included the following: a) Identification of training needs, planning and implementation of training schemes and development of transferable competencies and training materials. b) Mapping patient pathways and flow and c) Production of key documentation and Standard Operating Procedures for the delivery of the service.ResultsPhase 2 (Implementation and testing of the intervention): During the initial 12 months of implementation, remedial action was taken to address identified deficiencies regarding patient referral to the pathway, compliance with treatment protocol, patient follow up, selection challenges from the use of PESI in cancer patients and challenges regarding the "first-pass" identification of i-PE.ConclusionWe have developed and piloted a complex intervention to manage cancer patients with incidental PE in an outpatient setting. Adherence to evidence- based care, improvement of communication between professionals and patients, and improved quality of data is demonstrated.

Dataset Information

Safety, efficacy, length of stay and patient satisfaction with outpatient management of low-risk pulmonary embolism patients - a meta-analysis.

Introduction

Methods

Results

Conclusions

Publications

Safety, efficacy, length of stay and patient satisfaction with outpatient management of low-risk pulmonary embolism patients - a meta-analysis.

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