Joseph R Bledsoe1, Scott C Woller2, Scott M Stevens2, Valerie Aston3, Rich Patten4, Todd Allen5, Benjamin D Horne6, Lydia Dong7, James Lloyd8, Greg Snow9, Troy Madsen10, Patrick Fink10, C Gregory Elliott11. 1. The Department of Emergency Medicine, Stanford University-Intermountain Healthcare Delivery Institute, Salt Lake City, UT, United States of America. Electronic address: drjbledsoe@gmail.com. 2. The Department of Medicine, University of Utah-Intermountain Medical Center, Salt Lake City, UT, United States of America. 3. The Intermountain Office of Research, Intermountain Medical Center, Salt Lake City, UT, United States of America. 4. The Riverton Hospital, Riverton, UT, United States of America. 5. The Department of Emergency Medicine, Stanford University-Intermountain Healthcare Delivery Institute, Salt Lake City, UT, United States of America. 6. The Department of Cardiology, Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT, United States of America. 7. The Intermountain Healthcare-Intermountain Heart Institute, Salt Lake City, UT, United States of America. 8. The Department of Informatics, Intermountain Medical Center, Salt Lake City, UT, United States of America. 9. The Intermountain Statistical Data Center, Intermountain Medical Center, Salt Lake City, UT, United States of America. 10. The Department of Surgery, Division of Emergency Medicine, University of Utah SOM, Salt Lake City, UT, United States of America. 11. The Department of Medicine, University of Utah SOM, Intermountain Medical Center, Salt Lake City, UT, United States of America.
Abstract
OBJECTIVE: Evaluate the cost-effectiveness and difference in length-of-stay when patients in the ED diagnosed with low-risk pulmonary embolism (PE) are managed with early discharge or observation. METHODS: Single cohort prospective management study from January 2013 to October 2016 of patients with PE diagnosed in the ED and evaluated for a primary composite endpoint of mortality, recurrent venous thromboembolism, and/or major bleeding event at 90 days. Low-risk patients had a PE Severity Index score < 86, no evidence of proximal deep vein thrombosis on venous compression ultrasonography of both lower extremities, and no evidence of right heart strain on echocardiography. Patients were managed either in the ED or in the hospital on observation status. Primary outcomes were total length of stay, total encounter costs, and 30-day costs. RESULTS: 213 patients were enrolled. 13 were excluded per the study protocol. Of the remaining 200, 122 were managed with emergency department observation (EDO) and 78 with hospital observation (HO). One patient managed with EDO met the composite outcome due to a major bleeding event on day 61. The mean length of stay for EDO was 793.4 min (SD -169.7, 95% CI:762-823) and for HO was 1170 (SD -211.4, 95% CI:1122-1218) with a difference of 376.8 (95% CI: 430-323, p < 0.0001). Total encounter mean costs for EDO were $1982.95 and $2759.59 for HO, with a difference of $776.64 (95% CI: 972-480, p > 0.0001). 30-day total mean costs for EDO were $2864.14 and $3441.52 for HO, with a difference of $577.38 (95% CI: -1372-217, p = 0.15). CONCLUSIONS: Patients with low-risk PE managed with ED-based observation have a shorter length of stay and lower total encounter costs than patients managed with Hospital-based observation.
OBJECTIVE: Evaluate the cost-effectiveness and difference in length-of-stay when patients in the ED diagnosed with low-risk pulmonary embolism (PE) are managed with early discharge or observation. METHODS: Single cohort prospective management study from January 2013 to October 2016 of patients with PE diagnosed in the ED and evaluated for a primary composite endpoint of mortality, recurrent venous thromboembolism, and/or major bleeding event at 90 days. Low-risk patients had a PE Severity Index score < 86, no evidence of proximal deep vein thrombosis on venous compression ultrasonography of both lower extremities, and no evidence of right heart strain on echocardiography. Patients were managed either in the ED or in the hospital on observation status. Primary outcomes were total length of stay, total encounter costs, and 30-day costs. RESULTS: 213 patients were enrolled. 13 were excluded per the study protocol. Of the remaining 200, 122 were managed with emergency department observation (EDO) and 78 with hospital observation (HO). One patient managed with EDO met the composite outcome due to a major bleeding event on day 61. The mean length of stay for EDO was 793.4 min (SD -169.7, 95% CI:762-823) and for HO was 1170 (SD -211.4, 95% CI:1122-1218) with a difference of 376.8 (95% CI: 430-323, p < 0.0001). Total encounter mean costs for EDO were $1982.95 and $2759.59 for HO, with a difference of $776.64 (95% CI: 972-480, p > 0.0001). 30-day total mean costs for EDO were $2864.14 and $3441.52 for HO, with a difference of $577.38 (95% CI: -1372-217, p = 0.15). CONCLUSIONS:Patients with low-risk PE managed with ED-based observation have a shorter length of stay and lower total encounter costs than patients managed with Hospital-based observation.
Authors: Christopher Kabrhel; David R Vinson; Alice Marina Mitchell; Rachel P Rosovsky; Anna Marie Chang; Jackeline Hernandez-Nino; Stephen J Wolf Journal: J Am Coll Emerg Physicians Open Date: 2021-12-15