Kaitlyn D’Onofrio

DocwireNews

An integrated electronic clinical decision support system (CDSS) safely increased outpatient management for low-risk acute pulmonary embolism (PE) patients&nbsp;in a recent study.&nbsp;The study, published online in&nbsp;Annals of Internal Medicine, sought to determine if the CDSS could safely minimize the number of emergency department (ED) visits in PE patients whose condition could be managed in an outpatient setting.&nbsp;The controlled pragmatic trial took place between January 2014 and April 2015 and was set at Kaiser Permanent Northern&nbsp;California&rsquo;s 21 community&nbsp;EDs.&nbsp;After nine months, 10 EDs received a multidimensional technology and education intervention, while the other 11 sites became concurrent controls. The study&rsquo;s primary outcome was discharge from the ED or a short-term (&lt; 24-hour) ED-based outpatient observation unit to home. Adverse outcomes were PE-related symptoms that resulted in return visits within five days and recurrent venous thromboembolism, major hemorrhage, and all-cause mortality within 30 days.<a href="https://twitter.com/ClinicalPhase/status/1062120760494317568">https://twitter.com/ClinicalPhase/status/1062120760494317568</a>During the study, 881 eligible PE patients presented at intervention sites and 822 at control sites. Adjusted home discharge increased at intervention sites (17.4% pre- to 28.0% postintervention) but slightly decreased at control sites (15.1% pre- and 14.5% postintervention).&nbsp;CDSS implementation was not correlated with PE-related five-day return visits or in 30-day major adverse outcomes. Researchers observed a difference-in-differences comparison of 11.3 percentage points (95% confidence interval [CI], 3.0 to 19.5 percentage&nbsp;points;&nbsp;P&nbsp;= 0.007).&nbsp;Paul Stein, MD, and Mary J. Hughes, DO, both of Michigan State University College of Osteopathic Medicine in East Lansing,&nbsp;neither of whom were involved in the study,&nbsp;wrote an accompanying editorial in which they reveal that only about 6% of stable PE patients receive home treatment.&nbsp;&nbsp;&ldquo;Home treatment of pulmonary embolism (PE) is much preferred by patients: Most (88%) who received home treatment would choose it again rather than hospitalization,&rdquo; they wrote. &ldquo;It is also clearly cost-effective: If all eligible patients with PE seen in U.S. emergency departments were treated at home rather than in the hospital, health care costs would decrease by $1 billion per year. The evidence for safe home treatment of low-risk patients with acute PE is substantial.&rdquo;&nbsp;According to Stein,&nbsp;the question &ldquo;Why?&rdquo; is multifaceted.&nbsp;&nbsp;&ldquo;There are many reasons for this,&rdquo; he told&nbsp;<a href="https://www.medpagetoday.com/emergencymedicine/emergencymedicine/76291">MedPage&nbsp;Today</a>. &ldquo;Doctors in the emergency departments may be hurried or they may not be convinced that there will be proper follow-up. There&nbsp;has&nbsp;also been no standard criteria for identifying patients who are good candidates for home treatment.&rdquo;&nbsp;The study researchers concluded, &ldquo;The use of clinical decision support systems to bring validated risk-stratification tools to the ED bedside could help advance this agenda and could be expanded beyond PE to improve care and resource use for other clinical conditions.&rdquo;&nbsp;<a href="https://proddocwire.wpengine.com/cardiology/diagnose-prenatal-pulmonary-embolism/">A Safe Way to Diagnose Prenatal Pulmonary Embolism</a>&nbsp;<a href="https://proddocwire.wpengine.com/abstracts/pulmonary-embolism-severity-index/">Validation of simplified PESI score for identification of low-risk patients with pulmonary embolism: From the COMMAND VTE Registry</a>&nbsp;<a href="https://proddocwire.wpengine.com/docwire-pick/outpatient-engagement-decrease-suicide/">Outpatient Engagement May Decrease Suicide Risk in Fibromyalgia Patients</a>&nbsp;&nbsp;<a href="https://proddocwire.wpengine.com/conference-coverage/acr-conference-coverage/iq-lupus-program-decreases-hospitalizations-among-high-risk-patients/">IQ-Lupus Program Decreases Hospitalizations Among High-Risk Patients</a>&nbsp;Sources:&nbsp;<a title="Increasing Safe Outpatient Management of Emergency Department Patients With Pulmonary Embolism: A Controlled Pragmatic Trial" href="https://proddocwire.wpengine.com/conference-coverage/nih-grants-cardiac-transplantation/">Annals of Internal Medicine:&nbsp;Increasing Safe Outpatient Management of Emergency Department Patients With Pulmonary Embolism: A Controlled Pragmatic Trial</a>; <a href="http://annals.org/aim/article-abstract/2714294/mounting-evidence-safe-home-treatment-selected-patients-acute-pulmonary-embolism#">Mounting Evidence for Safe Home Treatment of Selected Patients With Acute Pulmonary Embolism</a>, <a href="https://www.healio.com/internal-medicine/cardiology/news/online/%7Baadbf41f-de5c-4bcd-a711-8f70b2dfb8de%7D/computer-tool-increases-safe-outpatient-management-of-pulmonary-embolism">Healio</a>

Jordana Jampel

FDA Approves Novel Blood Test for Alzheimer’s Detection

Dementia

Andrew Moreno

Is Plasma Mannose-Binding Lectin a Clue to Higher VTE Risk?

Katie Kosko

EMBER-3: Imlunestrant Plus Abemaciclib Improves PFS in ER+ Breast Cancer

HR Breast Cancer

Latest News

Electronic Tool Successfully Determines Eligible for Safe At-Home Pulmonary Embolism Management

Pulmonary Embolism

An integrated electronic clinical decision support system (CDSS) safely increased outpatient management for low-risk acute pulmonary embolism (PE) patients in a recent ...

Electronic Tool Successfully Determines Eligible for Safe At-home Pulmonary Embolism Management

About Us

Editorial Policy

Advertising

Contact Us

eNewsletters

Contribute

Career Center

MashupMD

Blood Cancers Today

Cancer Nursing Today

GU Oncology Now

Urban Health Today

Anemia

Deep Vein Thrombosis

Essential Thrombocythemia

Hemophilia

Immune Thrombocytopenic Purpura

Myelodysplastic Syndromes

Myelofibrosis

Myeloproliferative Neoplasms

Polycythemia Vera

Sickle Cell Disease

Thrombocytopenia

Thrombophilia

Thrombosis

Thrombotic Thrombocytopenic Purpura

Venous Thromboembolism

von Willebrand Disease

Heme Today

Acute Kidney Injury

ADPKD

Anemia and Kidney Disease

Chronic Kidney Disease

COVID-19 and Kidney Disease

Diabetes and Hypertension

End-Stage Renal Disease

Gout

Hyperkalemia

IgAN

Kidney Transplantation

Metabolic Acidosis

Nephrology Times

HER2 Breast Cancer

Triple-Negative Breast Cancer

Genetics & Breast Cancer

Breast Cancers Today

Atherosclerotic Disease

Atrial Fibrillation

Heart Failure

Hypertension

Interventional Cardiology

Lipid Management

Practice Tips With Dr. Lichaa

Preventive Cardiology

Stroke

Cardiology

Breast Cancer

Gynecologic Cancer

Head and Neck Cancer

Skin Cancer

Oncology

Sleep

Urology

Diabetes

Ophthalmology

— Demodex Blepharitis

Neurology

Rheumatology

Gastroenterology

Pulmonology

Infectious Diseases

— HIV

Health and Wellness

Lupus

Future of Medicine

Orthopedics

Pharmacology

Career News

More

Conferences

CardioNerds

The Sleep Source With Dr. Morse

Rheumatology Rounds With Dr. Maheswaranathan

Partners

Expert Interviews

Subscribe