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{ "pk": 11752, "title": "Emergency Department Patient Satisfaction with Treatment of Low-risk Pulmonary Embolism", "subtitle": null, "abstract": "Introduction:\n Many emergency department (ED) patients with acute pulmonary embolism (PE) who meet low-risk criteria may be eligible for a short length of stay (LOS) (<24 hours), with expedited discharge home either directly from the ED or after a brief observation or hospitalization. We describe the association between expedited discharge and site of discharge on care satisfaction and quality of life (QOL) among patients with low-risk PE (PE Severity Index [PESI] Classes I-III).\nMethods:\n This phone survey was conducted from September 2014 through April 2015 as part of a retrospective cohort study across 21 community EDs in Northern California. We surveyed low-risk patients with acute PE, treated predominantly with enoxaparin bridging and warfarin. All eligible patients were called 2-8 weeks after their index E D visit. PE-specific, patient-satisfaction questions addressed overall care, discharge instruction clarity, and LOS. We scored physical and mental QOL using a modified version of the validated Short Form Health Survey. Satisfaction and QOL were compared by LOS. For those with expedited discharge, we compared responses by site of discharge: ED vs. hospital, which included ED-based observation units. We used chi-square and Wilcoxon rank-sum tests as indicated.\nResults:\n Survey response rate was 82.3% (424 of 515 eligible patients). Median age of respondents was 64 years; 47.4% were male. Of the 145 patients (34.2%) with a LOS<24 hours, 65 (44.8%) were discharged home from the ED. Of all patients, 8 9.6% were satisfied with their overall care and 94.1% found instructions clear. Sixty-six percent were satisfied with their LOS, whereas 17.5% would have preferred a shorter LOS and 16.5% a longer LOS. There were no significant differences in satisfaction between patients with LOS<24 hours vs. ≥24 hours (p>0.13 for all). Physical QOL scores were significantly higher for expedited-discharge patients (p=0.01). Patients with expedited discharge home from the ED vs. the hospital had no significant difference in satisfaction (p>0.20 for all) or QOL (p>0.19 for all).\nConclusion:\n ED patients with low-risk PE reported high satisfaction with their care in follow-up surveys. Expedited discharge (<24 hours) and site of discharge were not associated with differences in patient satisfaction.", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Pulmonary embolism, patient preference, quality of life, length of stay, patient discharge" } ], "section": "Treatment Protocol Assessment", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/90s6r1mb", "frozenauthors": [ { "first_name": "Laura", "middle_name": "E.", "last_name": "Simon", "name_suffix": "", "institution": "Kaiser Permanente, Division of Research, Oakland, California", "department": "None" }, { "first_name": "Hilary", "middle_name": "R.", "last_name": "Iskin", "name_suffix": "", "institution": "University of Michigan Medical School, Ann Arbor, Michigan", "department": "None" }, { "first_name": "Ridhima", "middle_name": "", "last_name": "Vemula", "name_suffix": "", "institution": "University of Cincinnati College of Medicine, Cincinnati, Ohio", "department": "None" }, { "first_name": "Jie", "middle_name": "", "last_name": "Huang", "name_suffix": "", "institution": "Kaiser Permanente, Division of Research, Oakland, California", "department": "None" }, { "first_name": "Adina", "middle_name": "S.", "last_name": "Rauchwerger", "name_suffix": "", "institution": "Kaiser Permanente, Division of Research, Oakland, California", "department": "None" }, { "first_name": "Mary", "middle_name": "E.", "last_name": "Reed", "name_suffix": "", "institution": "Kaiser Permanente, Division of Research, Oakland, California", "department": "None" }, { "first_name": "Dustin", "middle_name": "W.", "last_name": "Ballard", "name_suffix": "", "institution": "Kaiser Permanente, Division of Research, Oakland, California\nKaiser Permanente San Rafael Medical Center, Department of Emergency Medicine,\nSan Rafael, California", "department": "None" }, { "first_name": "David", "middle_name": "R.", "last_name": "Vinson", "name_suffix": "", "institution": "Kaiser Permanente, Division of Research, Oakland, California\nKaiser Permanente Sacramento Medical Center, Department of Emergency Medicine, Sacramento, California", "department": "None" } ], "date_submitted": "2018-05-01T11:45:09-07:00", "date_accepted": "2018-05-01T11:45:09-07:00", "date_published": "2018-10-18T12:00:29-07:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/11752/galley/6308/download/" } ] }