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The impact of a pulmonary embolism response team on the efficiency of patient care in the emergency department

  • Colin WrightEmail author
  • Ayman Elbadawi
  • Yu Lin Chen
  • Dhwani Patel
  • Justin Mazzillo
  • Nicole Acquisto
  • Christine Groth
  • Joseph Van Galen
  • Joseph Delehanty
  • Anthony Pietropaoli
  • David Trawick
  • R. James White
  • Pamela Cameron
  • Igor Gosev
  • Bryan Barrus
  • Neil G. Kumar
  • Scott J. Cameron
Article

Abstract

The concept of a pulmonary embolism response team (PERT) is multidisciplinary, with the hope that it may positively impact patient care, hospital efficiency, and outcomes in the treatment of patients with intermediate and high risk pulmonary embolism (PE). Clinical characteristics of a baseline population of patients presenting with submassive and massive PE to URMC between 2014 and 2016 were examined (n = 159). We compared this baseline population before implementation of a PERT to a similar population of patients at 3-month periods, and then as a group at 18 months after PERT implementation (n = 146). Outcomes include management strategies and efficiency of the emergency department (ED) in diagnosing, treating, and dispositioning patients. Before PERT, patients with submassive and massive PE were managed fairly conservatively: heparin alone (85%), or additional advanced therapies (15%). Following PERT, submassive and massive PE were managed as follows: heparin alone (68%), or additional advanced therapies (32%). Efficiency of the ED in managing high risk PE significantly improved after PERT compared with before PERT; where triage to diagnosis time was reduced (384 vs. 212 min, 45% decrease, p = 0.0001), diagnosis to heparin time was reduced (182 vs. 76 min, 58% decrease, p = 0.0001), and the time from triage to disposition was reduced (392 vs. 290 min, 26% decrease, p < 0.0001). Our analysis showed that following PERT implementation, patients with intermediate and high risk acute PE received more aggressive and advanced treatment modalities and received significantly expedited care in the ED.

Keywords

Pulmonary embolism (PE) Venous thromboembolism (VTE) Pulmonary embolism response team (PERT) 

Notes

Author contributions

Study concept, design, and development of PERT (CW, JD, JM, AP, DT, JW, IG, SP, NK, and SC), data acquisition (CW, AE, YC, DP, JV, and SC), statistical analysis and interpretation (CW, PC, and SC), drafting of the manuscript (CW and SC).

Funding

The following financial funding agencies provided financial support: National Institutes of Health (NIH) grants NIH 3K08HL128856, and HL120200 to Dr. Cameron, and NIH grant UL1 TR002001 to the Clinical and Translational Science Institute at the University of Rochester.

Compliance with ethical standards

Conflicts of interest

All authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Colin Wright
    • 1
    • 2
    Email author
  • Ayman Elbadawi
    • 7
    • 8
  • Yu Lin Chen
    • 1
  • Dhwani Patel
    • 1
    • 9
  • Justin Mazzillo
    • 4
  • Nicole Acquisto
    • 4
  • Christine Groth
    • 3
  • Joseph Van Galen
    • 1
  • Joseph Delehanty
    • 1
    • 2
  • Anthony Pietropaoli
    • 1
    • 3
  • David Trawick
    • 1
    • 3
  • R. James White
    • 1
    • 3
    • 6
  • Pamela Cameron
    • 10
  • Igor Gosev
    • 5
  • Bryan Barrus
    • 5
  • Neil G. Kumar
    • 5
  • Scott J. Cameron
    • 1
    • 2
    • 5
    • 6
  1. 1.Department of MedicineUniversity of Rochester, School of Medicine and Dentistry and Strong Memorial HospitalRochesterUSA
  2. 2.Division of Cardiovascular DiseaseUniversity of Rochester, School of Medicine and Dentistry and Strong Memorial HospitalRochesterUSA
  3. 3.Division of Pulmonary-Critical Care MedicineUniversity of Rochester, School of Medicine and Dentistry and Strong Memorial HospitalRochesterUSA
  4. 4.Department of Emergency MedicineUniversity of Rochester, School of Medicine and Dentistry and Strong Memorial HospitalRochesterUSA
  5. 5.Department of Surgery, Division of Cardiac SurgeryUniversity of Rochester, School of Medicine and Dentistry and Strong Memorial HospitalRochesterUSA
  6. 6.Aab Cardiovascular Research InstituteUniversity of Rochester, School of Medicine and Dentistry and Strong Memorial HospitalRochesterUSA
  7. 7.Department of Internal MedicineRochester General HospitalRochesterUSA
  8. 8.Department of Medicine, Division of CardiologyUniversity of Texas Medical Branch at GalvestonGalvestonUSA
  9. 9.Department of MedicineNew York UniversityNew YorkUSA
  10. 10.Novo Science LtdEdinburghUK

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