More Bed Space


Hospitalists might be able to save their institutions time and money by shuttling out patients who have a low risk for acute pulmonary embolism (PE), according to one researcher.

Donald Yealy, MD, chair of the Department of Emergency Medicine at the University of Pittsburgh School of Medicine, was among the authors of a new study that reported that in certain cases, "outpatient care can safely and effectively be used in place of inpatient care" (Lancet. 2011;378(9785):41-48).

Dr. Yealy says HM should pay close attention to the results, as patients moved to the outpatient setting clear bed space for more acute cases. "[Hospitalists] should identify low-risk patients and try as quickly as possible to return patients to the setting they prefer: their home," he says.

In a primary analysis, the international noninferiority trial reported that one of 171 outpatients (0.006%) developed recurrent VTE within 90 days compared with none of 168 inpatients (95% upper confidence limit [UCL] 2.7%; P=0.011). Mean length of stay was 0.5 days for outpatients, compared with 3.9 days.

Dr. Yealy notes that the next step for research is to determine which treatment to use for PE cases, as his study focused just on where the treatment was rendered. He also notes that the review focused only on patients diagnosed by ED physicians as having a PE severity index risk class 1 or 2. He compares potential future treatment therapies to those for cancer patients, for which "not everyone who has cancer has a high risk for terrible outcomes."

"All pulmonary emboli are not the same," Dr. Yealy adds. "If you use a strategy that identifies the lowest-risk patients, you have a lot of options. … We need to right-size our approach."

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