Original ArticleAssessing the Impact of a Pulmonary Embolism Response Team and Treatment Protocol on Patients Presenting With Acute Pulmonary Embolism
Introduction
Pulmonary embolism (PE) is common, particularly in hospitalised patients, and can be life-threatening [1], [2]. However, PE care has traditionally been fragmented amongst multiple specialties, including critical care, emergency medicine, oncology, cardiology, haematology, vascular, respiratory and internal medicine. In recent years, international guidelines by the American College of Chest Physicians (ACCP), American Heart Association (AHA), and European Society of Cardiology (ESC) have reached a consensus and streamlined the management of PE [3], [4], [5]. Whilst anticoagulation remains the mainstay therapy for most patients, patients with massive PE or those with contraindications to anticoagulation may benefit from a myriad of non-pharmacological therapies that are usually not provided by the primary care team. To deliver timely and individualised care, based on consensus decision-making amongst multiple disciplines, the Pulmonary Embolism Response Team (PERT) model was developed [6]. In this study, consecutive patients who were treated at an academic medical centre for 2 years before and after the introduction of a hospital-wide PERT and treatment protocol for acute PE were tracked to determine the impact of such changes to clinical and quality outcomes.
Section snippets
Participants and Data Collection
This was a retrospective cohort study with historical controls. Consecutive adult patients with acute PE diagnosed by computed tomography pulmonary angiogram (CTPA) were identified from a comprehensive, electronic medical records system (CPSS2, IHIS, Singapore). The current institution does not use ventilation perfusion (V/Q) scans to diagnose acute PE. Patient characteristics, comorbidities, risk factors for PE, medication use, PE treatments, imaging, laboratory results, and clinical outcome
Demographics
A total of 321 patients were diagnosed and treated between 1 January 2013 and 31 December 2016; 154 patients treated in 2013 and 2014 formed the control group and 167 patients treated in 2015 and 2016 constituted the study group. More patients in the control group had concomitant heart failure (Table 1). The risk profile of patients was marginally higher in the post-protocol study group, with more patients having intermediate-high early mortality risk (based on ESC criteria) and fewer low-risk
Discussion
Introduction of a hospital-wide acute PE treatment protocol and response team resulted in a reduction in median ICU length of stay (especially amongst patients with intermediate risk or sub-massive PE), a significant increase in patients with massive PE receiving reperfusion therapies, more appropriate dosing of heparin therapies, and increased reporting of CTPA right heart strain parameters. These improvements were not associated with a measurable increase in short-term survival. Bleeding
Conclusions
The introduction of a PERT and management protocol reduced length of stay in intensive care, significantly increased the numbers of massive PE patients receiving reperfusion therapies, optimised dosing of anticoagulation, and improved quality measures. The long-term benefits of the PERT model in co-ordinating care of patients with PE warrant further studies.
Declarations of Interest
None.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Acknowledgements
We are grateful to Eleen Hui Er Lee, Ya Hui Lee, Yi Ping Ren, Teng Jie Shawn Tan, Yang Song and Tianjiao Zhang, who assisted in data collection.
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