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

Only 20.9% of low-risk pulmonary embolism patients received early discharge (<24 hours) at a Colombian tertiary hospital.

• Among 765 total pulmonary embolism patients, 62 (8.1%) were classified as low risk.
• Early discharge occurred in 13/62 patients (20.9%).
• The remaining 49/62 patients (79.1%) experienced longer hospital stays with a median of 3 days (IQR: 2–6).
• Low-risk PE was defined as simplified Pulmonary Embolism Severity Index of 0, absence of right ventricular dysfunction, and negative cardiac biomarkers.

Early discharge rates increased substantially over time, from 9.5% in the earlier period to 45% in the more recent period.

• Early discharge rate was 9.5% during 2019–2022.
• Early discharge rate rose to 45% during 2022–2024.
• The study was conducted within an Anticoagulation Stewardship Program at the institution.

Thirty-day outcomes were favorable for all patients, with no deaths, major bleeding events, or rehospitalizations.

• Zero deaths were recorded at 30 days.
• Zero major bleeding events occurred at 30 days.
• Zero rehospitalizations occurred at 30 days.
• Five patients revisited the emergency department for pain but did not require admission.

Delayed discharge was more frequent in patients with specific clinical characteristics and care settings.

• Delayed discharge was more frequent in patients with anemia, thrombocytopenia, and those receiving medications associated with increased bleeding risk.
• Patients managed outside the internal medicine service experienced more frequent delayed discharge.
• The median age of the cohort was 45.5 years (IQR: 32–62) and 36/62 (58.1%) were women.

Multiple system- and process-level barriers were documented as reasons for delayed discharge among the 49 patients not discharged early.

• Awaiting echocardiography was documented in 12/49 patients (24.5%).
• International normalized ratio monitoring was cited in 11/49 patients (22.4%).
• Other comorbidities accounted for delayed discharge in 11/49 patients (22.4%).
• Delayed direct oral anticoagulant dispensing or authorization was responsible in 9/49 patients (18.4%).
• Uncontrolled pain was documented in 6/49 patients (12.2%).