Background
Pulmonary embolism (PE) care has traditionally been fragmented. The newly introduced
Pulmonary Embolism Response Team (PERT) model provides streamlined care based on expedient,
multi-disciplinary decision-making. This study aimed to quantify the impact of PERT,
as part of a hospital-wide PE treatment protocol, on clinical outcomes.
Methods
Consecutive adult patients with acute PE diagnosed via computed tomography pulmonary
angiogram (CTPA) were included. The PERT and treatment protocol were introduced in
January 2015. Patient characteristics, therapies, quality measures of CTPA reporting,
and clinical outcomes of PE patients treated for 2 years before and after implementation
of these changes were evaluated. Primary endpoints were median length of stay in intensive
care (ICU) and survival to discharge.
Results
A total of 321 consecutive PE patients were enrolled, of which 154 (treated in 2013-2014)
and 167 (2015-2016) patients formed the historical control and study groups, respectively.
Implementation of the algorithm was associated with less variance in anticoagulation
and improved reporting of right heart strain parameters on CTPA. The ICU stay was
reduced from a median of 5 to 2 days (p < 0.01). Eligible massive PE patients receiving
reperfusion increased from 30% to 92% (p = 0.01), with mean delay from diagnosis to
reperfusion decreasing from 763 to 181 minutes (p < 0.01). Bleeding complications
were not increased, but overall survival to discharge remained unchanged.
Conclusions
Introducing a PERT and treatment protocol reduced ICU stay, enhanced quality measures,
and improved access of massive PE patients to reperfusion therapies, without increasing
bleeding complications or health care costs.
Keywords
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Article info
Publication history
Published online: March 07, 2019
Accepted:
February 17,
2019
Received in revised form:
January 14,
2019
Received:
September 11,
2018
Identification
Copyright
© 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
