Utilization and Safety of a Pulmonary Embolism Treatment Protocol in an Emergency Department Observation Unit


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Abstract

Pulmonary embolism (PE) is a common disease in emergency medicine and treatment approaches vary greatly. Emergency department observation units (EDOUs) have provided the opportunity to complete a PE workup, initiate treatment, and arrange appropriate follow-up for low-risk patients.Objective:We sought to evaluate the utilization and safety of a treatment protocol for low-risk PE in an EDOU.Methods:A prospective evaluation was performed in our EDOU for the treatment of low-risk PE between December 1, 2010 and May 31, 2012. The PE treatment protocol included telemetry monitoring, initiation of anticoagulation, performance of an echocardiogram, bilateral lower extremity duplex ultrasound, and consultation by the hospital’s thrombosis service to arrange outpatient follow-up. The primary outcome measure was inpatient admission and any complications during the EDOU stay or during a 30-day follow-up period.Results:Twelve patients were assigned to the EDOU for the PE treatment protocol during the 18-month study period. Six patients (50%) were admitted to an inpatient unit following the EDOU stay. Reasons for inpatient admission included hypoxia/worsening dyspnea (2), right ventricular strain on echocardiogram (1), large clot burden on duplex ultrasound (1), and lack of availability of testing/thrombosis service consultation during the EDOU stay (2). There were no adverse events in the EDOU. All patients reported compliance with outpatient follow-up, and none of the patients reported hospitalization or adverse events during the 30-day follow-up period. Utilization of the PE treatment protocol in our EDOU was surprisingly low (<1 patient/month), possibly because of provider awareness of the protocol.Conclusions:Although the overall inpatient admission rate from the EDOU was high, some of these cases related to logistical issues rather than medical concerns or complications. Further evaluation of an EDOU PE protocol may continue to demonstrate the safety and efficiency of this approach when compared with inpatient admission.

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