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J Thromb Thrombolysis. 2019 Aug;48(2):331-335. doi: 10.1007/s11239-019-01875-0.

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

Author information

1
Department of Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA. Colin_Wright@urmc.rochester.edu.
2
Division of Cardiovascular Disease, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA. Colin_Wright@urmc.rochester.edu.
3
Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA.
4
Department of Medicine, Division of Cardiology, University of Texas Medical Branch at Galveston, Galveston, TX, USA.
5
Department of Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
6
Department of Medicine, New York University, New York, NY, USA.
7
Department of Emergency Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
8
Division of Pulmonary-Critical Care Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
9
Division of Cardiovascular Disease, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
10
Aab Cardiovascular Research Institute, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
11
Novo Science Ltd, Edinburgh, EH27, UK.
12
Department of Surgery, Division of Cardiac Surgery, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.

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

PMID:
31102160
PMCID:
PMC6599732
[Available on 2020-08-01]
DOI:
10.1007/s11239-019-01875-0

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