Emergency Department Patient Satisfaction with Treatment of Low-risk Pulmonary Embolism

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 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.

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, 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).

Conclusion: 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.

Figure 1

Cohort assembly of emergency department patients with acute pulmonary embolism for telephone follow-up survey. ED, emergency department; PE, pulmonary embolism; VTE, venous thromboembolism; C/w, consistent with; MAPLE, Management of Acute PuLmonary Embolism study; PESI, Pulmonary Embolism Severity Index; LOS, length of stay.

Figure 2

Responses to satisfaction questions by patients with low-risk pulmonary embolism, stratified by length of stay (LOS). Note: There were no significant differences in satisfaction rates between patients with a LOS<24 hours and a LOS≥24 hours (p>0.13 for all).

Figure 3

Responses to satisfaction questions by patients with low-risk pulmonary embolism, stratified by site of discharge. LOS, length of stay. Note: There were no significant differences in satisfaction rates between patients discharged from the emergency department and the hospital (p>0.20 for all).

Figure 4

Physical and mental quality of life scores of patients with low-risk pulmonary embolism. ED, emergency department; QOL, quality of life. *No statistically significant differences found in patient QOL comparisons except for physical QOL when stratified by patient length of stay (p=0.01).