Electronic Support for Pulmonary Embolism Emergency Disposition

Increasing Safe Outpatient Care for Emergency Department Patients With Acute Pulmonary Embolism: a Pragmatic Trial

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.

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.

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
• Pregnant