The implementation of a pulmonary embolism response team in the management of intermediate- or high-risk pulmonary embolism
Open accessAbstract
Background Massive and submassive pulmonary embolism (PE) can be life-threatening. Treatment options include anticoagulation, fibrinolysis, catheter-directed or open surgical thrombus removal, and extracorporeal membrane oxygenation. With increasing patient complexity and advanced therapeutic options, the approach to optimal care for patients with intermediate- to high-risk PE is not clearly established. Multidisciplinary, rapid response teams can optimize risk stratification and expedite management. A PE response team (PERT) composed of specialists from cardiology, vascular surgery, emergency medicine, pulmonary and critical care, interventional radiology, cardiac surgery, hospital medicine, and pharmacy was created at our institution. The team is tasked with evaluating and treating patients with massive and submassive PE by use of a risk stratification and treatment algorithm. We describe our initial experience with this approach.Methods The records of patients treated by the PERT since inception in October 2015 through May 2017 were reviewed (intervention group). The diagnoses codes of the PERT patients were retrieved from the Vizient database. A retrospective control cohort group was created using these specific diagnoses and a matching set of demographics (age, sex), Medicare Severity Diagnosis Related Group, admission severity of illness, and admission risk of mortality. Statistical analysis was performed using the Fisher exact test, the Pearson χ 2 statistic, Student t-test, and Cochran-Cox approximation. P < .05 was considered significant.Results During the time interval, 77 patients with massive or submassive PE were treated by PERT activation; 992 patients included in the control group were treated at the discretion of an attending physician without use of the algorithm from October 2013 to 2016. Both groups had similar demographics, similar distribution of risk of mortality and severity of illness, and similar average Medicare Severity Diagnosis Related Group weighting. There was no statistically significant difference in the mortality rate between the two groups. The PERT group had significantly lower intensive care unit stay and overall length of stay. No difference was seen in direct cost between the two groups despite higher use of interventional treatment modalities in the PERT group.Conclusions In our institution, assembly of a dedicated team to treat patients with massive or submassive PE according to a clinical algorithm resulted in expedited treatment and reduced variation of care. Intensive care unit stay and overall length of stay were reduced by this approach, with no impact on direct cost despite the use of advanced modalities of treatment. We believe that this paradigm can be of potential value in other disease entities, particularly when multiple disciplines are involved.
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Multidisciplinary PE response teams have recently been implemented at several institutions to expedite rapid assessment and decision-making, but there has not been a demonstrated improvement in mortality with this approach.
“Multidisciplinary PE response teams have recently been implemented at several institutions to expedite rapid assessment and decision-making for these patients 207,208 ; however, there has not been a demonstrated improvement in mortality with this approach. 208,209”
From American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism (2020) · cites this paper as [208]
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Ortel, T. L., Neumann, I., Ageno, W., Beyth, R., Clark, N. P., Cuker, A., Hutten, B. A., Jaff, M. R., Manja, V., Schulman, S., et al. (2020) · Blood Advances · doi:10.1182/bloodadvances.2020001830 · Cited by 1,489 · see citing works
“Multidisciplinary PE response teams have recently been implemented at several institutions to expedite rapid assessment and decision-making for these patients(207,208); however, there has not been a demonstrated improvement in mortality with this approach.(208,209) Additional research with clinical outcomes is needed…”
Method
- Authors
- Xenos, E. S., Davis, G. A., He, Q., Green, A., & Smyth, S. S.
- Affiliations
- University of Kentucky HealthCare (US)
- Corresponding author
- Xenos, Eleftherios S.
- Venue
- Journal of Vascular Surgery: Venous and Lymphatic Disorders
- Publisher
- Elsevier BV
- Published
- 2019-07
- Volume
- 7
- Issue
- 4
- Pages
- 493-500
- ISSN
- 2213-333X (ISSN-L)
- OpenAlex
- W2929604573
- Cited by
- 85
- References
- 25
- Citations by year
- 2026: 7 · 2025: 12 · 2024: 15 · 2023: 12 · 2022: 11 · 2021: 8 · 2020: 14 · 2019: 5
- FWCI
- 7.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery Venous and Lymphatic Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- pulmonary embolism response team, massive pulmonary embolism, submassive pulmonary embolism, risk stratification, treatment algorithm, ICU length of stay, length of hospital stay, mortality, direct costs, fibrinolysis, anticoagulation, thrombus removal, extracorporeal membrane oxygenation
- MeSH terms
- Clinical Decision-Making, Adult, Aged, Algorithms, Female, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Outcome and Process Assessment, Health Care, Patient Care Team, Pulmonary Embolism, Retrospective Studies, Risk Factors, Severity of Illness Index, Time Factors, Program Evaluation, Databases, Factual, Treatment Outcome, Hospital Costs, Risk Assessment, Critical Pathways
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