Pulmonary Embolism
Conditions
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.
Interventions
OTHERIntegration of electronic clinical decision support
Integration of an electronic clinical decision support system into the emergency department patient care workflow to assist with site-of-care decision-making for emergency department patients with acute pulmonary embolism.
Sponsors
Kaiser Permanente
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
NONE
Intervention model description
Pragmatic clinical trial of a multidimensional technology and educational intervention undertaken over 16 months with an 8-month pre-intervention and an 8-month post-intervention period, conducted across 21 emergency departments with 10 serving as intervention and 11 as control sites.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
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 * Pregnant
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Rate of home discharge from the emergency department following treatment for pulmonary embolism | 8 months post-implementation compared to 8 months pre-implementation |
Secondary
| Measure | Time frame |
|---|---|
| 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 |
Countries
United States
Outcome results
None listed