Outpatient Management of Patients With Pulmonary Embolism
Authors: David R. Vinson, Dustin G. Mark, Dustin W. Ballard
Journal: Annals of Internal Medicine (2019)

Letters6 August 2019Outpatient Management of Patients With Pulmonary EmbolismDavid R. Vinson, MD, Dustin G. Mark, MD, and Dustin W. Ballard, MD, MBEDavid R. Vinson, MDThe Permanente Medical Group and Kaiser Permanente Northern California, Oakland, California (D.R.V., D.W.B.), Dustin G. Mark, MDThe Permanente Medical Group, Kaiser Permanente Northern California, and Kaiser Permanente Oakland Medical Center, Oakland, California (D.G.M.), and Dustin W. Ballard, MD, MBEThe Permanente Medical Group and Kaiser Permanente Northern California, Oakland, California (D.R.V., D.W.B.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L19-0208 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Roy and colleagues and Drs. Green and Patil are correct to highlight the critical role that onsite peer champions played in the implementation of the clinical decision-support system. The champion's literature-based educational sessions and iterative physician-specific audit and feedback informed physicians about safe ambulatory management of selected patients with PE. Approximately one third of patients who are classified as higher risk by the PESI score may be eligible to forgo hospitalization in the right setting (1). This explains why we avoided a strict application of the PESI score by using open language that suggested a site of ...References1. Erkens PM, Gandara E, Wells PS, et al. Does the Pulmonary Embolism Severity Index accurately identify low risk patients eligible for outpatient treatment? Thromb Res. 2012;129:710-4. [PMID: 21906787] doi:10.1016/j.thromres.2011.08.025 CrossrefMedlineGoogle Scholar2. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149:315-52. [PMID: 26867832] doi:10.1016/j.chest.2015.11.026 CrossrefMedlineGoogle Scholar3. Vinson DR, Morley JE, Huang J, et al; Kaisers Permanente CREST Network. The accuracy of an electronic pulmonary embolism severity index auto-populated from the electronic health record: setting the stage for computerized clinical decision support. Appl Clin Inform. 2015;6:318-33. [PMID: 26171078] doi:10.4338/ACI-2014-12-RA-0116 CrossrefMedlineGoogle Scholar4. Vinson DR, Ballard DW, Mark DG, et al; MAPLE investigators of the KP CREST Network. Risk stratifying emergency department patients with acute pulmonary embolism: does the simplified Pulmonary Embolism Severity Index perform as well as the original? Thromb Res. 2016;148:1-8. [PMID: 27764729] doi:10.1016/j.thromres.2016.09.023 CrossrefMedlineGoogle Scholar5. Parikh RB, Kakad M, Bates DW. Integrating predictive analytics into high-value care: the dawn of precision delivery. JAMA. 2016;315:651-2. [PMID: 26881365] doi:10.1001/jama.2015.19417 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: The Permanente Medical Group and Kaiser Permanente Northern California, Oakland, California (D.R.V., D.W.B.)The Permanente Medical Group, Kaiser Permanente Northern California, and Kaiser Permanente Oakland Medical Center, Oakland, California (D.G.M.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L19-0208. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIncreasing Safe Outpatient Management of Emergency Department Patients With Pulmonary Embolism David R. Vinson , Dustin G. Mark , Uli K. Chettipally , Jie Huang , Adina S. Rauchwerger , Mary E. Reed , James S. Lin , Mamata V. Kene , David H. Wang , Dana R. Sax , Tamara S. Pleshakov , Ian D. McLachlan , Cyrus K. Yamin , Andrew R. Elms , Hilary R. Iskin , Ridhima Vemula , Donald M. Yealy , Dustin W. Ballard , and Outpatient Management of Patients With Pulmonary Embolism Pierre-Marie Roy , Guy Meyer , Olivier Sanchez , and Menno Huisman Outpatient Management of Patients With Pulmonary Embolism James F.J. Green and Vinodkumar Patil Metrics Cited byManagement and Outcomes of Adults Diagnosed with Acute Pulmonary Embolism in Primary Care: Community-Based Retrospective Cohort StudySustainability of a Clinical Decision Support Intervention for Outpatient Care for Emergency Department Patients With Acute Pulmonary EmbolismHospitalization Is Less Common in Ambulatory Patients With Acute Pulmonary Embolism Diagnosed Before Emergency Department Referral Than After ArrivalPresyncope Is Associated with Intensive Care Unit Admission in Emergency Department Patients with Acute Pulmonary Embolism 6 August 2019Volume 171, Issue 3Page: 228KeywordsClinical decision support systemsDisclosureElectronic medical recordsHospitalizationsMortalityOutpatientsPatient advocacyPulmonary embolismThoraxTreatment guidelines ePublished: 6 August 2019 Issue Published: 6 August 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...