title: A Multidisciplinary Pulmonary Embolism Response Team: Initial 30-Month Experience With a Novel Approach to Delivery of Care to Patients With Submassive and Massive Pulmonary Embolism.
abstract: Integrating newly developed tests and treatments for severe pulmonary embolism (PE) into clinical care requires coordinated multispecialty collaboration. To meet this need, we developed a new paradigm: a multidisciplinary Pulmonary Embolism Response Team (PERT). In this report, we provide the first longitudinal analysis of patients treated by a PERT.
  
  
  
  Our PERT includes specialists in cardiovascular medicine and surgery, emergency medicine, hematology, pulmonary/critical care, and radiology, and is organized as a rapid response team. We prospectively captured clinical, therapeutic, and outcome data at PERT activation and during follow-up periods up to 365 days. We analyzed data collectively, and as five mutually exclusive 6-month periods. We performed Fisher exact tests and regression analysis to test for trend.
  
  
  
  In 30 months, there were 394 unique PERT activations, 314 (80%) for confirmed PE. PERT activations increased by 16% every 6 months. Most confirmed PEs were submassive (n = 143, 46%) or massive (n = 80, 26%). The PERT treated a relatively large proportion of patients with PE and systemic or catheter-directed thrombolysis (n = 35, 11%), though the most common treatment was anticoagulation alone (n = 215, 69%). Hemorrhagic complications were rare overall, especially among patients treated with catheter-directed thrombolysis. The all-cause 30-day mortality of PERT patients with confirmed PE was 12%.
  
  
  
  We report our initial 30-month experience with a novel multidisciplinary PERT that rapidly engages multiple specialists to deliver efficient, organized, and evidence-based care to patients with high-risk PE. The PERT paradigm was rapidly adopted and may become a new standard of care for patients with PE.
authors.affiliation: Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: ckabrhel@partners.org.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kabrhel
authors.affiliation: Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Rosovsky
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Richard
authors.initials: R
authors.lastname: Channick
authors.affiliation: Fireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jaff
authors.affiliation: Fireman Vascular Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Ido
authors.initials: I
authors.lastname: Weinberg
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Thoralf
authors.initials: T
authors.lastname: Sundt
authors.affiliation: Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: David M
authors.initials: DM
authors.lastname: Dudzinski
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Josanna
authors.initials: J
authors.lastname: Rodriguez-Lopez
authors.affiliation: Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Blair A
authors.initials: BA
authors.lastname: Parry
authors.affiliation: Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Savanah
authors.initials: S
authors.lastname: Harshbarger
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rosenfield
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D002309:Cardiology; D002407:Catheterization, Swan-Ganz; D003695:Delivery of Health Care / Q000458:organization & administration*; D004635:Emergency Medicine; D005260:Female; D006405:Hematology; D006470:Hemorrhage / Q000139:chemically induced; D006769:Hospitals, General; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000628:therapy*; D015272:Pulmonary Medicine; D011871:Radiology; D012720:Severity of Illness Index; D013903:Thoracic Surgery; D017131:Thrombectomy; D015912:Thrombolytic Therapy
chemical_list: D000925:Anticoagulants
keywords: deep vein thrombosis; pulmonary embolism; rapid response team; thrombolysis; thrombosis