Low-Risk Pulmonary Embolism Patients

In partnership with the University of Michigan, Munson Medical Center is launching an initiative effective March 1, 2025, to decrease admission of low-risk, stable pulmonary emboli patients. This initiative is part of a larger statewide quality improvement initiative named Michigan Emergency Department Improvement Collaborative (MEDIC). If this initiative is successful, it may be expanded to other Munson Healthcare Emergency Departments.

Guidance for Primary Care Providers

• Eligibility: Eligible patients are those diagnosed in the MMC ED with pulmonary emboli who have:

  • stable vital signs
  • no sign of myocardial injury or heart strain
  • minimal symptoms
• Treatment: MMC’s ED will initiate and prescribe the 1st month of Eliquis including the loading week of medication.

• Follow-up/Continuity of Care:

  • Patients should be seen by their primary care provider within 5 days of discharge from MMC’s ED. Patients without a PCP or those unable to be seen expeditiously will be referred to the Munson Family Practice Center for their follow-up care.
  • Patients will be provided the following Pulmonary Embolism discharge instructions.
    • You have been diagnosed with pulmonary embolism (PE), a condition involving a blood clot in the arteries that receive oxygen from the lungs. The most common cause of PE is deep vein thrombosis (DVT), a blood clot in a large vein typically from the arm or leg.
    • While some cases of PE can be very serious, most people with PE are at low overall risk of severe outcomes. Your provider(s) at Munson have evaluated you carefully and determined that home treatment is a safe option for you.
    • The key treatment for PE is a blood thinner (“anticoagulant”). For most people, this will be either Xarelto (rivaroxaban) or Eliquis (apixaban). Follow the dosing instructions for your anticoagulant exactly as prescribed. Contact us if you have any difficulty obtaining this prescription. Do not stop this medication without first speaking with your provider.
    • It is very important for you to follow-up closely with your primary care provider (within 5 days). If you cannot see your routine provider within 5 days, please contact the Munson Family Practice Clinic at 231-935-8000.
    • Call 911 or seek emergency evaluation immediately for any other following: chest pain, trouble breathing, coughing up blood, fast heartbeat, profuse sweating, fainting, fall-related injuries (particularly head injury), heavy or uncontrolled bleeding.
    • You may always contact our “Ask-A-Nurse” line (231-935-0951) if you are unsure about the urgency of your symptoms.
  • Recommendations for PCP Follow-up:
    • Re-evaluation: Symptomatic control, oxygenation, vitals. Is the patient tolerating the PE?
    • Education: Particularly with anticoagulant use, expected course for recovery, reassurance
    • Mental Health Assessment: Anxiety has been outlined as a reason for ED return and targeted by the University of Michigan to address patient concerns over diagnosis.
    • Medication Access: Ensure patient was able to access prescribed anticoagulants. The first dose will be administered in ED and then the patient will be discharged with a coupon to pick up additional medication.