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- Title
Emergency Department Patient Satisfaction with Treatment of Low-risk Pulmonary Embolism.
- Authors
Simon, Laura E.; Iskin, Hilary R.; Vemula, Ridhima; Jie Huang; Rauchwerger, Adina S.; Reed, Mary E.; Ballard, Dustin W.; Vinson, David R.
- Abstract
Introduction: 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). Methods: 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, patientsatisfaction 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. Results: 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 patien ts (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). Conclusion: ED patients with low-risk PE reported high satisfaction with their care in followup surveys. Expedited discharge (<24 hours) and site of discharge were not associated with differences in patient satisfaction.
- Subjects
CALIFORNIA; WARFARIN; DRUG therapy; ENOXAPARIN; COMMUNITY health services; CHI-squared test; HEALTH surveys; LENGTH of stay in hospitals; HOSPITAL admission &; discharge; HOSPITAL emergency services; LONGITUDINAL method; MEDICAL appointments; MEDICAL quality control; PATIENT satisfaction; PULMONARY embolism; QUALITY of life; QUESTIONNAIRES; SURVEYS; CELL phones; PATIENT discharge instructions; RETROSPECTIVE studies; SEVERITY of illness index; MANN Whitney U Test; EMBOLISM risk factors; THERAPEUTICS
- Publication
Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 2018, Vol 19, Issue 6, p938
- ISSN
1936-900X
- Publication type
Article
- DOI
10.5811/westjem.2018.9.38865