Kaiser Permanente, Division of Research, Oakland, California.
University of Michigan Medical School, Ann Arbor, Michigan.
West J Emerg Med. 2018 Nov;19(6):938-946. doi: 10.5811/westjem.2018.9.38865. Epub 2018 Oct 18.
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).
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 ED 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.
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, 89.6% 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).
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.
许多符合低危标准的急性肺栓塞（PE）急诊科（ED）患者可能有资格接受短住院时间（<24 小时），通过 ED 直接或短暂观察或住院后迅速出院。我们描述了在低危 PE（PE 严重指数 [PESI] Ⅰ-Ⅲ级）患者中，加速出院与出院地点之间的关系，与患者的满意度和生活质量（QOL）有关。
这是一项电话调查，于 2014 年 9 月至 2015 年 4 月在加利福尼亚州北部的 21 家社区急诊科进行，作为一项回顾性队列研究的一部分。我们调查了接受依诺肝素桥接和华法林治疗的急性低危 PE 患者。所有符合条件的患者在 ED 就诊后 2-8 周内被呼叫。PE 特异性的患者满意度问题涉及整体护理、出院指导清晰度和住院时间。我们使用经过验证的简短健康调查的改良版本来评分身体和精神 QOL。通过住院时间来比较满意度和 QOL。对于加速出院的患者，我们通过出院地点进行比较：ED 与医院，包括 ED 内的观察单位。如需要，我们使用卡方检验和 Wilcoxon 秩和检验。
调查应答率为 82.3%（515 名合格患者中的 424 名）。受访者的中位年龄为 64 岁；47.4%为男性。在 145 名住院时间<24 小时的患者中，有 65 名（44.8%）从 ED 出院回家。在所有患者中，89.6%对整体护理满意，94.1%认为指导清晰。66%对住院时间满意，而 17.5%希望住院时间更短，16.5%希望住院时间更长。住院时间<24 小时与≥24 小时的患者满意度无显著差异（所有 p>0.13）。加速出院患者的身体 QOL 评分显著更高（p=0.01）。从 ED 快速出院回家的患者与从医院出院的患者在满意度（所有 p>0.20）或 QOL（所有 p>0.19）方面无显著差异。
在随访调查中，低危 PE 的 ED 患者报告对其护理非常满意。加速出院（<24 小时）和出院地点与患者满意度无差异相关。
