Achieving Multidisciplinary Collaboration for the Creation of a Pulmonary Embolism Response Team: Creating a “Team of Rivals”

Abstract

Pulmonary embolism response teams (PERTs) have recently been developed to streamline care for patients with life-threatening pulmonary embolism (PE). PERTs are unique among rapid response teams, in that they bring together a multidisciplinary team of specialists to care for a single disease for which there are novel treatments but few comparative data to guide treatment. The PERT model describes a process that includes activation of the team; real-time, multidisciplinary consultation; communication of treatment recommendations; mobilization of resources; and collection of research data. Interventional radiologists, along with cardiologists, emergency physicians, hematologists, pulmonary/critical care physicians, and surgeons, are core members of most PERTs. Bringing together such a wide array of experts leverages the expertise and strengths of each specialty. However, it can also lead to challenges that threaten team cohesion and cooperation. The purpose of this article is to discuss ways to integrate multiple specialists, with diverse perspectives and skills, into a cohesive PERT. The authors will discuss the purpose of forming a PERT, strengths of different PERT specialties, strategies to leverage these strengths to optimize participation and cooperation across team members, as well as unresolved challenges.

Early-term outcomes of the pulmonary embolism response team

“… 5 Experts in the field of emergency medicine, cardiovascular surgery, cardiology, chest diseases, anesthesiology, radiology, hematology clinics can contribute to PERTs according to the patient’s structure and the experience of the relevant clinics. 10 PERTs also provide effective triage for PE patients, stabilization and determination of the most effective treatment method i.e. medical therapy, catheter-directed treatment or surgery).…”

“… 5 After the establishment of PERT, increased usage of extra-corporal membrane oxygenation (1.7% vs 7.89%), increased usage of CDT (1.8% vs 46.3%); decreased intensive care unit (ICU) staying time (6.9 ± 9.4 vs 4.4 ± 5.1 days) and hospital staying time (9.2 ± 16.1 vs 6.3 ± 7.4 days) were reported. 13 Kabrhel et al 10 declared that the number of patients consulted every 6 months after the PERT team was established increased by 6%. Pulmonary embolism was detected in 80% of the patients consulted, and approximately 70% of them had submassive and massive pulmonary embolisms; however, 10% of the patients had undergone ST or CDT.…”

“…Pulmonary embolism was detected in 80% of the patients consulted, and approximately 70% of them had submassive and massive pulmonary embolisms; however, 10% of the patients had undergone ST or CDT. 10 Sista et al 14 , applied CDT to 27% of their patients and ST therapy to 7% of their patients whom they consulted with PERT. Carroll et al 1 performed CDT on 11% of 70 patients evaluated with PERT and ST therapy 18% of them.…”

Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions

“…Occasionally, and if feasible, the patient or a family member is included in those conversations. To date, there are 32 published descriptions or reviews of how various PERTs establish, organize, operate, and/or manage their programs (Table ) . To identify published studies on PERT, we conducted a systematic search of the literature for publications in MEDLINE and EMBASE from inception to November 2018 using the following search strategy: (pulmonary) and (embolism) and (response) and (team or teams) or (PERT) or (PERTs).…”

Communication at diagnosis of venous thromboembolism: Lasting impact of verbal and nonverbal provider communication on patients

“… 15 , 16 , 17 , 18 , 19 , 20 However, patients with severe acute VTE may benefit from the addition of invasive “reperfusion strategies.” Although current literature suggests that clinical equipoise and considerable controversy exists over this decision, if reperfusion strategies are likely to help, experts believe they should be initiated within a few hours of diagnosis. 21 , 22 , 23 , 24 The diagnosis of VTE and its treatment thus represent a model system of an emergent condition that requires immediate decision making under conditions of uncertainty regarding optimal treatment choice and where both the failure to treat and the complications from treatment can be life threatening. Furthermore, most of these patients will present to the emergency department (ED), where a patient–health care provider relationship has not been developed or maintained.…”