Increasing Safe Outpatient Care for Emergency Department Patients With Acute Pulmonary Embolism: a Pragmatic Trial
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Kaiser Permanente
- Enrollment
- 1,703
- Locations
- 14
- Primary Endpoint
- Rate of home discharge from the emergency department following treatment for pulmonary embolism
Study Overview
Brief Summary
To evaluate the impact of an integrated electronic clinical decision support system to facilitate risk stratification and site-of-care decision-making for patients with acute pulmonary embolism.
Detailed Description
Many low-risk emergency department patients with acute pulmonary embolism are routinely hospitalized despite being eligible for outpatient care. One impediment to home discharge is the difficulty of identifying which patients can safely forego hospitalization. This pragmatic clinical trial intends to evaluate the effect on emergency department disposition of a multicomponent intervention, including electronic clinical decision support system access, physician education, and physician-specific audit and feedback. The hypothesis for this study is that intervention sites, when compared with concurrent control sites, will see an increase in home discharges without an increase in 5-day pulmonary embolism-related return visits or 30-day all-cause mortality.
Study Design
- Study Type
- Interventional
- Allocation
- Non Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Diagnostic
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Acute objectively-confirmed pulmonary embolism, diagnosed in the emergency department
Exclusion Criteria
- •Comfort-care only
- •Left the ED against medical advice
- •Current PE radiologically diagnosed >12 hrs prior to arrival
- •Recent DVT or PE diagnosed within 30 days
Arms & Interventions
Intervention
Intervention: Integration of electronic clinical decision support (Other)
Control
Outcomes
Primary Outcomes
Rate of home discharge from the emergency department following treatment for pulmonary embolism
Time Frame: 8 months post-implementation compared to 8 months pre-implementation
Secondary Outcomes
- Number of participants with major hemorrhage, recurrent venous thromboembolism, and all-cause mortality(30 days)
- Number of participants with return visits for pulmonary embolism-related signs, symptoms, or interventions(5 days)