A structured programme raised outpatient care of low-risk PE from 5% to 33%, with no 30-day deaths

Design

Single-centre implementation study, before and after

Population

1,810 ED patients with acute PE, 705 low-PESI

Primary outcome

Proportion of low-PESI patients discharged from the ED

Effect

5.1% to 33.3% (OR 9.24, 95% CI 5.04–16.92); no 30-day VTE recurrence or death after discharge

One US academic emergency department introduced a multicomponent intervention to address barriers to discharging low-risk pulmonary embolism, and tracked 1,810 patients with acute PE over six years.

Among 705 with a low PESI score (85 or less), ED discharge rose from 5.1% before the programme to 33.3% in its third year (OR 9.24). There were no recurrent venous thromboembolism or deaths within 30 days of any ED discharge, and bleeding was rare and minor.

Admission fell mostly among patients without Hestia criteria. Counting only low-PESI, Hestia-negative patients, discharge reached 75%. That suggests combining the two tools to define who should go home — PESI for risk, Hestia for practical and social reasons to stay.

• Use a validated score such as PESI or sPESI to identify low-risk PE
• Apply Hestia criteria to catch practical reasons for admission
• Arrange anticoagulation and early follow-up before discharging
• Expect most low-risk, Hestia-negative patients to be safely managed as outpatients

Why it matters

Most low-risk PE is still admitted by habit, not by need.

Don't overread it

This is a single-centre before-and-after study, not a randomised comparison of safety.

The statistics, in plain English

The odds ratio of 9.24 compares the odds of discharge in year three with the baseline period; it reflects change in practice, not a treatment effect.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.