Treatment of patients with pulmonary embolism entirely in Hospital in the Home.

Abstract

BACKGROUND: Low molecular weight heparin (LMWH) has revolutionised the management of venous thromboembolism (VTE). An important feature of the use of LMWH is the ability to manage acute VTE in the home. This study examined the outcomes of patients with pulmonary embolism (PE) who were transferred to Hospital in the Home (HIH) within 24 hours of presentation for treatment with LMWH. METHODS: The authors reviewed records of all patients with PE who presented to two major hospitals in Melbourne (Victoria) and who were transferred to HIH for treatment with LMWH within 24 hours of presentation. The main outcome measures were length of stay, unexpected staff callouts, unexpected returns to hospital, recurrent embolism, bleeding, and death. RESULTS: Twenty-one patients were included in the study over 5 years, with a mean age of 56 years. Patients spent a mean of 9 hours in hospital before transfer and spent a mean of 6 nights in HIH. One patient required an unexpected staff callout. There were no unexpected returns to hospital. No patient deaths or instances of major bleeding were recorded. Three patients developed minor bleeding. DISCUSSION: Despite the long study period, this is a small cohort of patients and no control group is offered. However, all eligible patients were included in the study. With appropriate risk assessment and medical model of HIH, it might be safe to treat low risk patients with PE in HIH for their entire hospital stay.