To evaluate the impact of an integrated electronic clinical decision support system to facilitate risk stratification and site-of-care decision-making for patients with acute pulmonary embolism.
Many low-risk emergency department patients with acute pulmonary embolism are routinely hospitalized despite being eligible for outpatient care. One impediment to home discharge is the difficulty of identifying which patients can safely forego hospitalization. This pragmatic clinical trial intends to evaluate the effect on emergency department disposition of a multicomponent intervention, including electronic clinical decision support system access, physician education, and physician-specific audit and feedback. The hypothesis for this study is that intervention sites, when compared with concurrent control sites, will see an increase in home discharges without an increase in 5-day pulmonary embolism-related return visits or 30-day all-cause mortality.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
1,703
Integration of an electronic clinical decision support system into the emergency department patient care workflow to assist with site-of-care decision-making for emergency department patients with acute pulmonary embolism.
Kaiser Permanente Fremont Emergency Department
Fremont, California, United States
Kaiser Permanente Oakland Emergency Department
Oakland, California, United States
Rate of home discharge from the emergency department following treatment for pulmonary embolism
Time frame: 8 months post-implementation compared to 8 months pre-implementation
Number of participants with major hemorrhage, recurrent venous thromboembolism, and all-cause mortality
Time frame: 30 days
Number of participants with return visits for pulmonary embolism-related signs, symptoms, or interventions
Time frame: 5 days
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Kaiser Permanente Redwood City Emergency Department
Redwood City, California, United States
Kaiser Permanente Richmond Emergency Department
Richmond, California, United States
Kaiser Permanente Roseville Emergency Department
Roseville, California, United States
Kaiser Permanente South Sacramento Emergency Department
Sacramento, California, United States
Kaiser Permanente Sacramento Emergency Department
Sacramento, California, United States
Kaiser Permanente San Francisco Emergency Department
San Francisco, California, United States
Kaiser Permanente San Jose Emergency Department
San Jose, California, United States
Kaiser Permanente San Leandro Emergency Department
San Leandro, California, United States
...and 4 more locations