Adherence and barriers to early discharge for patients with low-risk pulmonary embolism at a Latin American tertiary center: A retrospective cohort study

Abstract

Objective: To describe adherence to early discharge (<24 h) among patients with low-risk pulmonary embolism and to characterize barriers to its implementation. Methods: This was a descriptive, retrospective cohort study conducted within an Anticoagulation Stewardship Program at a Colombian tertiary hospital. Low-risk pulmonary embolism was defined as simplified Pulmonary Embolism Severity Index of 0, absence of right ventricular dysfunction, and negative cardiac biomarkers. Outcomes at 30 days included mortality, major bleeding, and rehospitalization. Results: Among 765 patients with pulmonary embolism, 62 were classified as low risk. The median age was 45.5 years (interquartile range: 32–62) and 36/62 (58.1%) were women. Early discharge occurred in 13/62 patients (20.9%), whereas 49/62 (79.1%) experienced longer hospital stay (median, 3 days (interquartile range: 2–6)). Early discharge rates increased from 9.5% (2019–2022) to 45% (2022–2024). Thirty-day outcomes were favorable, with no deaths, major bleeding events, or rehospitalizations. Five patients revisited the emergency department for pain but did not require admission. Delayed discharge was more frequent in patients with anemia, thrombocytopenia, those receiving medications associated with increased bleeding risk, and in those managed outside the internal medicine service. Documented reasons for delayed discharge included awaiting echocardiography (12/49), international normalized ratio monitoring (11/49), other comorbidities (11/49), delayed direct oral anticoagulants dispensing or authorization (9/49), and uncontrolled pain (6/49). Conclusions: Adherence to early discharge for low-risk pulmonary embolism was limited despite excellent short-term safety outcomes. System- and process-level barriers, particularly echocardiography utilization, warfarin/international normalized ratio requirements, direct oral anticoagulants access, and pain management, may be addressed through standardized discharge pathways and diagnostic stewardship.