Background
Outpatient treatment is guideline-supported for carefully selected, low-risk PE. The operational problem is not just risk prediction. Patients need medication in hand, clear discharge instructions, and reliable early follow-up.
38.4%
Treated at home in Hestia arm
Roy et al., 2021
1.33%
30-day composite outcome (VTE, bleed, death)
HOME-PE
0
Recurrent or fatal PE
HOME-PE
Local Problem
Low-risk PE patients may still be admitted for logistics: medication cost, uncertain access, incomplete documentation, or lack of fast follow-up.
Each avoidable admission adds boarding time, inpatient cost, and patient disruption without changing the anticoagulation plan.
Measures
Process
Pathway use · DOAC load · Voucher use · Aftercare message sent
Outcome
PE admission rate · 72-hour follow-up completion
Balancing
ED return visits · Bleeding events · Recurrent VTE · First-fill failure
Aim & ED Workflow
Design a standardized Hestia-based ED discharge pathway for hemodynamically stable patients with confirmed acute PE who meet safety, medication access, and follow-up criteria.
−20%
Target after launch: reduce logistically
driven PE admissions
1
Diagnose
Confirmed
acute PE
→
→
→
→
5
Close Loop
72-hr
follow-up
Hard stops: instability · bleeding risk · oxygen need · renal failure · pregnancy · HIT history · social instability · medication access failure · clinician concern
Intervention Bundle
-
☑
Hestia Screen.HESTIAPE documents all 11 no-go criteria at disposition.
-
💊
DOAC LoadApixaban 10 mg or rivaroxaban 15 mg given and tolerated before discharge.
-
💳
Medication AccessVoucher workflow addresses first-fill cost before the patient reaches the pharmacy.
-
📅
72-Hour Follow-UpEpic Secure Message to ED Aftercare with appointment details in discharge paperwork.
Implementation Status
-
Materials finalized: operational protocol, Epic SmartPhrases, nursing note, patient instructions, and SmartSet checklist.
-
Launch phase: Epic SmartSet build, voucher-folder placement, and Aftercare referral workflow confirmation.
Anticipated Impact
A low-risk PE discharge pathway can convert evidence into an operational bundle: risk stratification, medication access, and reliable follow-up.
This poster reports design and implementation readiness. Outcome analysis will follow after launch.
Clinical Safety Filters
❤️Hemodynamics
SBP ≥100 and HR <110 without PE-related instability
🩸Bleeding Risk
No active bleeding or high-risk bleeding condition
💨Oxygen Need
No oxygen requirement expected beyond 24 hours
⚕️Treatment Complexity
No thrombolysis, embolectomy, HIT, pregnancy, severe renal/liver impairment
🏠Social Stability
Housing, phone, pharmacy access, and ability to return
👤Clinician Judgment
Physician-in-charge may overrule discharge when the story does not fit
Instability · Thrombolysis/embolectomy need · Bleeding risk · Oxygen need · PE on anticoagulation · IV analgesia need · Medical or social admission need · CrCl <30 · Severe liver disease · Pregnancy · HIT history
Hestia-negative status is necessary, not sufficient. Medication access, follow-up, and clinician judgment still decide discharge.
Equity Logic
Medication access is treated as a safety criterion, not an afterthought.
- ✉️$0 first-fill voucher when cost is a barrier
- 📄Clear discharge packet and return precautions in plain language
Next Steps
- Complete Epic SmartSet build.
- Confirm Aftercare scheduling pathway and callback loop.
- Launch pilot with weekly review of process, outcome, and balancing measures.
- Report first post-launch run chart once sufficient cases accrue.
Project Summary
We designed a Hestia-based outpatient PE pathway for a high-volume Bronx safety-net ED. The pathway embeds low-risk PE screening into Epic through .HESTIAPE, a PE Discharge SmartSet, 72-hour Aftercare referral, and a voucher workflow for first-fill DOAC access. Planned measures include pathway use, follow-up completion, ED returns, and admission rates among Hestia-negative patients. Target after launch: 20% reduction in logistically driven PE admissions.
References: Roy PM et al. Eur Heart J. 2021 · Becattini C et al. Eur Heart J. 2021 · ACEP Clinical Policy: Acute Venous Thromboembolic Disease · 2026 Multisociety Acute PE Guideline
No outcome claims are made before launch. This poster describes the evidence-informed intervention, implementation package, and planned evaluation.