Initiation of an emergency department discharge pathway for low-risk patients with venous thromboembolism: Factors impact real-world practice - Scorecard - MDSpire
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Initiation of an emergency department discharge pathway for low-risk patients with venous thromboembolism: Factors impact real-world practice
Clinical Scorecard: Implementation of a Discharge Protocol for Low-Risk Venous Thromboembolism Patients in Emergency Departments: Influencing Factors on Practical Application
At a Glance
Category
Detail
Condition
Venous thromboembolism (VTE)
Key Mechanisms
Risk stratification tools and direct oral anticoagulants (DOACs) facilitate outpatient treatment.
Target Population
Adults (age ⩾ 18 years) presenting with VTE in the emergency department.
Care Setting
Emergency department
Key Highlights
VTE is the third most common cardiovascular disorder with an annual incidence of one in 1000 persons.
Approximately 30–50% of patients with PE may be low risk and safe for discharge.
The pathway for outpatient treatment was implemented on July 1, 2016.
A natural language processing tool was developed to accurately identify VTE diagnoses.
The study evaluated patient characteristics and outcomes before and after pathway initiation.
Guideline-Based Recommendations
Diagnosis
Use validated decision rules such as the Pulmonary Embolism Severity Index (PESI).
Employ natural language processing tools for accurate diagnosis identification.
Management
Implement a comprehensive outpatient treatment pathway for low-risk VTE patients.
Provide anticoagulation education and a 30-day DOAC prescription.
Monitoring & Follow-up
Schedule a 1-week follow-up with an outpatient provider in a vascular medicine clinic.
Risks
Monitor for major bleeding events as defined by ISTH criteria within 30 days of ED presentation.
Patient & Prescribing Data
Low-risk VTE patients identified in the emergency department.
Direct oral anticoagulants (DOACs) are used for outpatient management.
Clinical Best Practices
Standardize risk stratification processes in emergency departments.
Facilitate timely specialty follow-up for patients discharged with VTE.
by William B Stubblefield, James Barclay, Jesse O Wrenn, Doug Conway, Scott Nelson, Quinn S Wells, Dario Giuse, Zhao Zuo, Alexandra M Baird, Tyler Barrett, Shi Huang, Karen Beauchamp, Alan B Storrow, Sean P Collins, Joshua A Beckman
