title: The creation and implementation of an outpatient pulmonary embolism treatment protocol.
abstract: The ability to rapidly and accurately risk-stratify patients with venous thromboembolism (VTE), and the availability of direct acting oral anticoagulants have reduced the need for intravenous anticoagulation for patients with deep vein thrombosis (DVT) and pulmonary embolism (PE). Emergency physicians are generally reluctant to discharge patients with VTE without defined and reliable follow up in place, and VTE patients treated with anticoagulants can be at risk for complications related to recurrent VTE and bleeding. In addition, screening for associated diseases (e.g. cancer, hypercoagulable states) may be indicated. Therefore, the outpatient treatment of low risk VTE requires coordinated effort and reliable follow up. By leveraging detailed outcome data and collaborative relationships, we have created a protocol for the safe outpatient treatment of patients with low risk DVT and PE. Our protocol is data driven and designed to address barriers to outpatient VTE management. We expect our protocol to result in improved patient satisfaction, more efficient emergency department (ED) throughput, and decreased cost. Applied nationally, the outpatient treatment of select patients with DVT and PE could have major public health and economic impact.
authors.affiliation: a Center for Vascular Emergencies, Department of Emergency Medicine , Massachusetts General Hospital , Boston , MA , USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kabrhel
authors.affiliation: b Division of Hematology and Oncology, Department of Medicine , Massachusetts General Hospital , Boston , MA , USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosovsky
authors.affiliation: c Department of Emergency Medicine , Brigham and Women's Hospital , Boston , MA , USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Baugh
authors.affiliation: a Center for Vascular Emergencies, Department of Emergency Medicine , Massachusetts General Hospital , Boston , MA , USA.
authors.forename: Blair Alden
authors.initials: BA
authors.lastname: Parry
authors.affiliation: a Center for Vascular Emergencies, Department of Emergency Medicine , Massachusetts General Hospital , Boston , MA , USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Deadmon
authors.affiliation: a Center for Vascular Emergencies, Department of Emergency Medicine , Massachusetts General Hospital , Boston , MA , USA.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Kreger
authors.affiliation: a Center for Vascular Emergencies, Department of Emergency Medicine , Massachusetts General Hospital , Boston , MA , USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Giordano
mesh_terms: D000359:Aftercare / Q000458:organization & administration* / Q000592:standards; D000553:Ambulatory Care / Q000458:organization & administration* / Q000592:standards; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D002985:Clinical Protocols; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D010045:Outpatients; D011655:Pulmonary Embolism / Q000517:prevention & control*; D018570:Risk Assessment; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Anticoagulation; Deep Vein Thrombosis; Emergency Department; Outpatient; Pulmonary Embolism; Treatment; Venous Thromboembolism