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IntroductionMany emergency department (ED) patients with acute pulmonary embolism (PE) who meet low-risk criteria may be eligible for a short length of stay (LOS) (<24 hours), with expedited discharge home either directly from the ED or after a brief observation or hospitalization. We describe the association between expedited discharge and site of discharge on care satisfaction and quality of life (QOL) among patients with low-risk PE (PE Severity Index [PESI] Classes I–III).MethodsThis phone survey was conducted from September 2014 through April 2015 as part of a retrospective cohort study across 21 community EDs in Northern California. We surveyed low-risk patients with acute PE, treated predominantly with enoxaparin bridging and warfarin. All eligible patients were called 2–8 weeks after their index ED visit. PE-specific, patient-satisfaction questions addressed overall care, discharge instruction clarity, and LOS. We scored physical and mental QOL using a modified version of the validated Short Form Health Survey. Satisfaction and QOL were compared by LOS. For those with expedited discharge, we compared responses by site of discharge: ED vs. hospital, which included ED-based observation units. We used chi-square and Wilcoxon rank-sum tests as indicated.ResultsSurvey response rate was 82.3% (424 of 515 eligible patients). Median age of respondents was 64 years; 47.4% were male. Of the 145 patients (34.2%) with a LOS<24 hours, 65 (44.8%) were discharged home from the ED. Of all patients, 89.6% were satisfied with their overall care and 94.1% found instructions clear. Sixty-six percent were satisfied with their LOS, whereas 17.5% would have preferred a shorter LOS and 16.5% a longer LOS. There were no significant differences in satisfaction between patients with LOS<24 hours vs. ≥24 hours (p>0.13 for all). Physical QOL scores were significantly higher for expedited-discharge patients (p=0.01). Patients with expedited discharge home from the ED vs. the hospital had no significant difference in satisfaction (p>0.20 for all) or QOL (p>0.19 for all).ConclusionED patients with low-risk PE reported high satisfaction with their care in follow-up surveys. Expedited discharge (<24 hours) and site of discharge were not associated with differences in patient satisfaction.

SummaryObjective: Adoption of clinical decision support (CDS) tools by clinicians is often limited by workflow barriers. We sought to assess characteristics associated with clinician use of an electronic health record-embedded clinical decision support system (CDSS). Methods: In a prospective study on emergency department (ED) activation of a CDSS tool across 14 hospitals between 9/1/14 to 4/30/15, the CDSS was deployed at 10 active sites with an on-site champion, education sessions, iterative feedback, and up to 3 gift cards/clinician as an incentive. The tool was also deployed at 4 passive sites that received only an introductory educational session. Activation of the CDSS -which calculated the Pulmonary Embolism Severity Index (PESI) score and provided guidance -and associated clinical data were collected prospectively. We used multivariable logistic regression with random effects at provider/facility levels to assess the association between activation of the CDSS tool and characteristics at: 1) patient level (PESI score), 2) provider level (demographics and clinical load at time of activation opportunity), and 3) facility level (active vs. passive site, facility ED volume, and ED acuity at time of activation opportunity). Results: Out of 662 eligible patient encounters, the CDSS was activated in 55%: active sites: 68% (346/512); passive sites 13% (20/150). In bivariate analysis, active sites had an increase in activation rates based on the number of prior gift cards the physician had received (96% if 3 prior cards versus 60% if 0, p<0.0001). At passive sites, physicians < age 40 had higher rates of activation (p=0.03). In multivariable analysis, active site status, low ED volume at the time of diagnosis and PESI scores I or II (compared to III or higher) were associated with higher likelihood of CDSS activation. Conclusions: Performing on-site tool promotion significantly increased odds of CDSS activation. Optimizing CDSS adoption requires active education. Research Article Background and SignificanceThe goal of knowledge translation (KT) is to close the gap between proven science and real-time care delivery. Historically, the adoption of new evidence into clinical practice has lagged a decade or more -with variable uptake across physicians and settings [1,2]. While KT, and implementation science more generally, are relatively new fields of emphasis and study, previous work has identified barriers to effective KT as well as best practices for implementation [3].For example, Davidoff has stressed the importance of concentrating not only on the diffusion of new validated techniques and treatments into practice but also on the "undiffusion" of previous practice -especially amongst those physicians who may be prone to suffering from inertia when it comes to changing their practice [4]. Michie has described a behavior change wheel framework for identifying well-suited interventions (e.g., education, environmental context, etc.) to combat barriers to implementation of knowledge translation tools [5]. Diner has de...

anxious individuals who received the intervention reported significantly lower anxiety before pelvic examination (P5,.001, partial h25.232) and after (P5.006, partial h25.165) compared to control. Analysis of covariance controlling for baseline pain found individuals who received the intervention rated pelvic examination as significantly less painful (P5, .01, partial h25.075) compared to control. Intervention participants reported high interest, acceptability, and helpfulness of the mindful movement video. CONCLUSION:A 5-minute mindful movement video viewed prior to pelvic examination significantly lowered anxiety for individuals with clinically significant anxiety and reduced perceived painfulness of pelvic examination. This study demonstrates the ability to integrate a brief mindfulness intervention into the flow of a medical clinic and reduce pelvic exam anxiety and pain.