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

Authors

Colin Wright, Department of Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
Ayman Elbadawi, Rochester Regional HealthFollow
Yu Lin Chen, Department of Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
Dhwani Patel, Department of Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
Justin Mazzillo, Department of Emergency Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
Nicole Acquisto, Department of Emergency Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
Christine Groth, Division of Pulmonary-Critical Care Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
Joseph Van Galen, Department of Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
Joseph Delehanty, Department of Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
Anthony Pietropaoli, Department of Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
David Trawick, Department of Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
R James White, Department of Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
Pamela Cameron, Novo Science Ltd, Edinburgh, EH27, UK.
Igor Gosev, Department of Surgery, Division of Cardiac Surgery, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
Bryan Barrus, Department of Surgery, Division of Cardiac Surgery, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
Neil G. Kumar, Department of Surgery, Division of Cardiac Surgery, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.
Scott J. Cameron, Department of Medicine, University of Rochester, School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, NY, USA.

Department

Internal Medicine

Document Type

Article

Publication Title

Journal Of Thrombosis And Thrombolysis

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.

First Page

331

Last Page

335

DOI

10.1007/s11239-019-01875-0

Volume

48

Issue

2

Publication Date

8-1-2019

Medical Subject Headings

Emergency Service, Hospital (organization & administration, standards); Humans; Patient Care (standards); Patient Care Team (standards); Pulmonary Embolism (therapy); Time-to-Treatment

PubMed ID

31102160

Recommended Citation

Wright, C., Elbadawi, A., Chen, Y. L., Patel, D., Mazzillo, J., Acquisto, N., Groth, C., Van Galen, J., Delehanty, J., Pietropaoli, A., Trawick, D., James White, R., Cameron, P., Gosev, I., Barrus, B., Kumar, N. G., & Cameron, S. J. (2019). The impact of a pulmonary embolism response team on the efficiency of patient care in the emergency department. Journal Of Thrombosis And Thrombolysis, 48 (2), 331-335. https://doi.org/10.1007/s11239-019-01875-0