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Correspondence |

Diversity in the Pulmonary Embolism Response Team Model: An Organizational Survey of the National PERT Consortium Members FREE TO VIEW

Geoffrey D. Barnes, MD; Christopher Kabrhel, MD, MPH; D. Mark Courtney, MD; Soophia Naydenov, MD; Todd Wood, MD; Rachel Rosovsky, MD; Kenneth Rosenfield, MD; Jay Giri, MD, MPH
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following: G. D. B. received support from NHLBI [grant T32-HL007853]. J. G. received modest research funds to the institution from St. Jude Medical. None declared (C. K., D. M. C., S. N., T. W., R. R., K. R.).

aFrankel Cardiovascular Center and Institute for Healthcare Policy and Innovation, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI

bCenter for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

cDepartment of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL

dDivision of Pulmonary Critical Care and Sleep Medicine, St. Louis University School of Medicine, St. Louis, MO

eDivision of Cardiology, Lancaster General Health, University of Pennsylvania Medicine, Lancaster, PA

fDivision of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

gDivision of Cardiology, Section of Vascular Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA

hPenn Cardiovascular Outcomes, Quality and Evaluative Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

CORRESPONDENCE TO: Geoffrey D. Barnes, MD, Frankel Cardiovascular Center, University of Michigan, 2800 Plymouth Rd, Bldg 14-G101, Ann Arbor, MI 48109


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(6):1414-1417. doi:10.1016/j.chest.2016.09.034
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Published online

Pulmonary embolism response teams (PERTs) have been rapidly developing in the United States to bring multidisciplinary care to patients with acute pulmonary embolism.,,, However, the diversity of PERT program structure and their association with hospital characteristics have not yet been described.

Using a modified Delphi method, we developed and administered an online organizational survey of active National PERT Consortium members between April and June 2016 (response rate, 80%). Of the 31 institutions surveyed, 22 (71% academic) responded, and among these PERT programs started more often in 2014/2015 (14; 74%) than in 2012/2013 (5; 26%). Specialties most commonly involved in PERTs were as follows: pulmonary/critical care (84%), interventional cardiology (79%), and emergency medicine (63%) (Fig 1). All programs involved at least two specialties (median, four; interquartile range, three to six), without correlation to hospital size or academic/teaching status (P > .3 for both). Most programs reported 6 to 10 or 11 to 20 (8 respondents, 42%, each) monthly activations while a minority (3, 16%) reported 1 to 5 monthly activations. Most PERT activations originated in the ED, medical or cardiac intensive care unit, or medical floor (Fig 2). In most institutions (12; 63%) a full, multidisciplinary team responded to the initial PERT activation. Less often (6; 32%) a tiered approach was used, with a single physician consultation for the initial response and a multidisciplinary team-based discussion for more complex cases. Most programs had guidelines for when a PERT consultation is considered “appropriate” (16; 84%), with some variation between institutions (Fig 3).

Figure Jump LinkFigure 1 Specialty involvement in pulmonary embolism response teams. Shown is the percentage of institutions with pulmonary embolism response team involvement from each specialty. CC = critical care.Grahic Jump Location

Figure Jump LinkFigure 2 Most common locations for pulmonary embolism response team consultations. Shown is the percentage of institutions identifying each hospital location as a “most common” location for pulmonary embolism response team consultations.Grahic Jump Location

Figure Jump LinkFigure 3 Appropriate indications for pulmonary embolism response team (PERT) activation. Shown is the percentage of active PERT programs reporting that each indication is deemed “appropriate” for a PERT activation. IVC = inferior vena cava; PE = pulmonary embolism.Grahic Jump Location

The PERT model for team-based consultation and care of patients with acute pulmonary embolism is rapidly gaining traction in the United States. PERT programs are now as diverse as the institutions in which they are being formed. While interventional (catheter-based and surgical) physicians are usually involved in PERT programs, the most commonly involved specialty (pulmonary/critical care) does not traditionally employ catheter or surgical interventions to treat pulmonary embolism.

The outcomes associated with PERT programs are largely unknown at this time. However, the National PERT Consortium is presently organizing a multicenter registry to capture the patient characteristics, medical decision making, and clinical outcomes for all patients with PERT consultations.

As the National PERT Consortium continues to develop and more PERT programs form, it will become increasingly important to understand the impact of this multidisciplinary team-based approach to the treatment of acute pulmonary embolism on quality of care. In addition, adopting standardized definitions for pulmonary embolism severity and establishing best treatment protocols will be essential for the next iteration of clinical care guidelines and future performance/quality measures.

Kabrhel C. .Jaff M.R. .Channick R.N. .Baker J.N. .Rosenfield K. . A multidisciplinary pulmonary embolism response team. Chest. 2013;144:1738-1739 [PubMed]journal. [CrossRef] [PubMed]
 
Provias T. .Dudzinski D.M. .Jaff M.R. .et al 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. Hospital Practice. 2014;42:31-37 [PubMed]journal
 
Reza N. .Dudzinski D.M. . Pulmonary embolism response teams. Curr Treat Options Cardiovasc Med. 2015;17:387- [PubMed]journal. [PubMed]
 
Kabrhel C. .Rosovsky R. .Channick R. .et al A multidisciplinary Pulmonary Embolism Response Team (PERT): initial 30-month experience with a novel approach to delivery of care to patients with sub-massive and massive PE. Chest. 2016;150:384-393 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1 Specialty involvement in pulmonary embolism response teams. Shown is the percentage of institutions with pulmonary embolism response team involvement from each specialty. CC = critical care.Grahic Jump Location
Figure Jump LinkFigure 2 Most common locations for pulmonary embolism response team consultations. Shown is the percentage of institutions identifying each hospital location as a “most common” location for pulmonary embolism response team consultations.Grahic Jump Location
Figure Jump LinkFigure 3 Appropriate indications for pulmonary embolism response team (PERT) activation. Shown is the percentage of active PERT programs reporting that each indication is deemed “appropriate” for a PERT activation. IVC = inferior vena cava; PE = pulmonary embolism.Grahic Jump Location

Tables

References

Kabrhel C. .Jaff M.R. .Channick R.N. .Baker J.N. .Rosenfield K. . A multidisciplinary pulmonary embolism response team. Chest. 2013;144:1738-1739 [PubMed]journal. [CrossRef] [PubMed]
 
Provias T. .Dudzinski D.M. .Jaff M.R. .et al 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. Hospital Practice. 2014;42:31-37 [PubMed]journal
 
Reza N. .Dudzinski D.M. . Pulmonary embolism response teams. Curr Treat Options Cardiovasc Med. 2015;17:387- [PubMed]journal. [PubMed]
 
Kabrhel C. .Rosovsky R. .Channick R. .et al A multidisciplinary Pulmonary Embolism Response Team (PERT): initial 30-month experience with a novel approach to delivery of care to patients with sub-massive and massive PE. Chest. 2016;150:384-393 [PubMed]journal. [CrossRef] [PubMed]
 
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