The impact of a pulmonary embolism response team on the efficiency of patient care in the emergency department
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.
KeywordsPulmonary embolism (PE) Venous thromboembolism (VTE) Pulmonary embolism response team (PERT)
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).
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.
- 4.Goldhaber SZ (2015) Deep venous thrombosis and pulmonary thromboembolism. In: Kasper D, Fauci A, Hauser S, Longo D, Jameson JL, Loscalzo J (eds) Harrison’s Principles of Internal Medicine, 19e. McGraw-Hill Education, New YorkGoogle Scholar
- 6.Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, Jenkins JS, Kline JA, Michaels AD, Thistlethwaite P, Vedantham S, White RJ, Zierler BK, American Heart Association Council on Cardiopulmonary CCP, Resuscitation, American Heart Association Council on Peripheral Vascular D, American Heart Association Council on Arteriosclerosis T, Vascular B (2011) Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 123(16):1788–1830. https://doi.org/10.1161/CIR.0b013e318214914f CrossRefGoogle Scholar
- 7.Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galie N, Gibbs JS, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Vonk Noordegraaf A, Zamorano JL, Zompatori M, Task Force for the D, Management of Acute Pulmonary Embolism of the European Society of C (2014) 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35(43):3033-3069, 3069a-3069 k. https://doi.org/10.1093/eurheartj/ehu283
- 9.Provias T, Dudzinski DM, Jaff MR, Rosenfield K, Channick R, Baker J, Weinberg I, Donaldson C, Narayan R, Rassi AN, Kabrhel C (2014) The massachusetts general hospital pulmonary embolism response team (MGH PERT): creation of a multidisciplinary program to improve care of patients with massive and submassive pulmonary embolism. Hosp Pract 42(1):31–37. https://doi.org/10.3810/hp.2014.02.1089 CrossRefGoogle Scholar
- 10.Kabrhel C, Rosovsky R, Channick R, Jaff MR, Weinberg I, Sundt T, Dudzinski DM, Rodriguez-Lopez J, Parry BA, Harshbarger S, Chang Y, Rosenfield K (2016) A multidisciplinary pulmonary embolism response team: initial 30-month experience with a novel approach to delivery of care to patients with submassive and massive pulmonary embolism. Chest 150(2):384–393. https://doi.org/10.1016/j.chest.2016.03.011 CrossRefGoogle Scholar
- 11.Deadmon EK, Giordano NJ, Rosenfield K, Rosovsky R, Parry BA, Al-Bawardy RF, Chang Y, Kabrhel C (2017) Comparison of emergency department patients to inpatients receiving a pulmonary embolism response team (PERT) activation. Acad Emerg Med 24(7):814–821. https://doi.org/10.1111/acem.13199 CrossRefGoogle Scholar
- 12.Rosovsky R, Chang Y, Rosenfield K, Channick R, Jaff MR, Weinberg I, Sundt T, Witkin A, Rodriguez-Lopez J, Parry BA, Harshbarger S, Hariharan P, Kabrhel C (2018) Changes in treatment and outcomes after creation of a pulmonary embolism response team (PERT), a 10-year analysis. J Thromb Thrombolysis. https://doi.org/10.1007/s11239-018-1737-8 Google Scholar
- 13.Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42(2):377–381. https://doi.org/10.1016/j.jbi.2008.08.010 CrossRefGoogle Scholar