386 Prevalence of Abnormal Uterine Bleeding in a Multicenter Implementation Study Using Apixaban and Rivaroxaban to Treat Venous Thromboembolism

Abstract

emergency department (PED) on home oxygen (O2). We initiated an evidencebased home O2 pathway intended for low-risk bronchiolitis patients who require supplemental O2 but have no other indications for hospitalization. Our low-risk criteria for inclusion in the home O2 pathway include: history and exam consistent with bronchiolitis, age 3-36 months and corrected gestational age > 48 weeks, no chronic medical illness, no history of apnea, no significant increased work of breathing, maintaining oral hydration, O2 saturation 90% on 0.5 liters per minute (LPM) O2 by nasal cannula, caregiver comfort with discharge, patient able to follow up easily (<30 minute travel time to the hospital, available transportation and telephone). Patients meeting criteria are observed for 4 hours in the PED to ensure no deterioration. We require a ten-minute room air trial to confirm that in case of temporary nasal cannula dislodgement patients remain stable on room air. This retrospective review aims to describe the outcomes of PED bronchiolitis patients discharged on home O2 and to evaluate the efficacy and safety of the home O2 pathway.Methods: We retrospectively reviewed records for all patients who were placed on the PED home O2 pathway and/or discharged on home O2 from the PED. We reviewed demographic information, details of the initial PED visit and observation period, disposition, and follow-up. We reviewed reasons for hospital admission in cases of patients who were not discharged after initiation of the home O2 pathway. We determined whether discharged home O2 patients had repeat PED visits and/or admission to the hospital within 7 days of PED discharge.Results: 39 children met criteria and were placed on the PED home O2 pathway between December 2017 and May 2021. 14 patients were admitted to the hospital after the initial PED observation period for reasons including: increased O2 requirement ( 9), increased work of breathing ( 5), caregiver discomfort with discharge (2) and PED provider discomfort with discharge (1). No admitted patients required intubation or admission to the intensive care unit (ICU). 3 patients required high flow nasal cannula O2 delivery. Of the 25 patients who were discharged home after the PED observation period, 1 patient returned on the 5 th day and was admitted to the ICU. This patient received high flow O2 and did not require intubation. 2 patients had a return visit to the PED and both were discharged home. Patients may have had other return visits to an outside hospital, which is a limitation of our study.Conclusion: Our data supports the safety of a PED home O2 pathway for bronchiolitis patients meeting low-risk criteria. Only 1 of our discharged home O2 patients returned and required admission. Home O2 therapy appears to be a safe disposition alternative for low-risk bronchiolitis patients.