title: Timing of discharge follow-up for acute pulmonary embolism: retrospective cohort study.
abstract: BACKGROUND
  Historically, emergency department (ED) patients with pulmonary embolism (PE) have been admitted for several days of inpatient care. Growing evidence suggests that selected ED patients with PE can be safely discharged home after a short length of stay. However, the optimal timing of follow up is unknown. We hypothesized that higher-risk patients with short length of stay (<24 hours from ED registration) would more commonly receive expedited follow up (≤3 days).
  
  
  METHODS
  This retrospective cohort study included adults treated for acute PE in six community EDs. We ascertained the PE Severity Index risk class (for 30-day mortality), facility length of stay, the first follow-up clinician encounter, unscheduled return ED visits ≤3 days, 5-day PE-related readmissions, and 30-day all-cause mortality. Stratifying by risk class, we used multivariable analysis to examine age- and sex-adjusted associations between length of stay and expedited follow up.
  
  
  RESULTS
  The mean age of our 175 patients was 63.2 (±16.8) years. Overall, 93.1% (n=163) of our cohort received follow up within one week of discharge. Fifty-six patients (32.0%) were sent home within 24 hours and 100 (57.1%) received expedited follow up, often by telephone (67/100). The short and longer length-of-stay groups were comparable in age and sex, but differed in rates of low-risk status (63% vs 37%; p<0.01) and expedited follow up (70% vs 51%; p=0.03). After adjustment, we found that short length of stay was independently associated with expedited follow up in higher-risk patients (adjusted odds ratio [aOR] 3.5; 95% CI [1.0-11.8]; p=0.04), but not in low-risk patients (aOR 2.2; 95% CI [0.8-5.7]; p=0.11). Adverse outcomes were uncommon (<2%) and were not significantly different between the two length-of-stay groups.
  
  
  CONCLUSIONS
  Higher-risk patients with acute PE and short length of stay more commonly received expedited follow up in our community setting than other groups of patients. These practice patterns are associated with low rates of 30-day adverse events.
authors: The Permanente Medical Group, Oakland, California ; Kaiser Permanente Roseville Medical Center, Roseville, California ; Kaiser Permanente Division of Research, Oakland, California.
authors: David R
authors: DR
authors: Vinson
authors: The Permanente Medical Group, Oakland, California ; Kaiser Permanente Division of Research, Oakland, California ; Kaiser Permanente San Rafael Medical Center, San Rafael, California.
authors: Dustin W
authors: DW
authors: Ballard
authors: Kaiser Permanente Division of Research, Oakland, California.
authors: Jie
authors: J
authors: Huang
authors: Kaiser Permanente Division of Research, Oakland, California.
authors: Adina S
authors: AS
authors: Rauchwerger
authors: Kaiser Permanente Division of Research, Oakland, California.
authors: Mary E
authors: ME
authors: Reed
authors: The Permanente Medical Group, Oakland, California ; Kaiser Permanente Oakland Medical Center, Oakland, California.
authors: Dustin G
authors: DG
authors: Mark
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011655:Pulmonary Embolism / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult