Effect of a Multidisciplinary Pulmonary Embolism Response Team on Patient Mortality

Wright, Colin M.; Goldenberg, Ilan; Schleede, Susan; McNitt, Scott; Gošev, Igor; Elbadawi, Ayman; Pietropaoli, Anthony P.; Barrus, Bryan; Chen, Yu Lin; Mazzillo, Justin; Acquisto, Nicole M.; Galen, Joseph Van; Hamer, Annelise; Marinescu, Mark; Delehanty, Joseph M.; Cameron, Scott J.

doi:10.1016/j.amjcard.2021.08.066

Cited by 40 publications

(28 citation statements)

References 16 publications

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“…We included a large sample size of patients and not only described the types of interventions pharmacists can make as a member of the PERT, but also demonstrated an association with clinically important outcomes, such as improvement in time from diagnosis to anticoagulation and increased use of LMWH, which have both been associated with a decrease in mortality in patients with PE. [8][9][10] We also found an association between the pharmacist as a member of the PERT and reduced major bleeding demonstrating an overall improvement in patient safety. Data from our own institution evaluating the efficiency of PE care in the ED following PERT implementation found that triage to diagnosis time was reduced 45% (384 vs 212 minutes), diagnosis to anticoagulation time was reduced 58% (182 vs 76 minutes), and time from triage to disposition was reduced 26% (392 vs 290 minutes) between the pre-PERT (May 2014-December 2015) compared to post-PERT periods (November 2016-April 2018) 11 Interestingly, the post-PERT period in this study included 4 months of data where the pharmacist was not yet a member of the bedside team; however, we speculated that the 12 months that the pharmacist was involved likely impacted this result.…”

Section: Discussionmentioning

confidence: 54%

“…This study is the first report to specifically describe and evaluate the pharmacist's role on a PERT. We included a large sample size of patients and not only described the types of interventions pharmacists can make as a member of the PERT, but also demonstrated an association with clinically important outcomes, such as improvement in time from diagnosis to anticoagulation and increased use of LMWH, which have both been associated with a decrease in mortality in patients with PE 8‐10 . We also found an association between the pharmacist as a member of the PERT and reduced major bleeding demonstrating an overall improvement in patient safety.…”

Section: Discussionmentioning

confidence: 91%

“…8,9 There is also potential to promote the choice of heparinoid product as low molecular weight heparin (LMWH) compared to unfractionated heparin (UFH) has been associated with improved survival. 10 An interdisciplinary PERT was implemented at our institution for patients with confirmed massive or submassive PE. Shortly after implementation, it was determined that a pharmacist should be an integral component of a PERT based on their highly specialized and complementary skillset.…”

Section: Introductionmentioning

confidence: 99%

“…It is suspected that PERT may have similar benefits as it has been shown that delayed time to anticoagulation is associated with poor outcome 8,9 . There is also potential to promote the choice of heparinoid product as low molecular weight heparin (LMWH) compared to unfractionated heparin (UFH) has been associated with improved survival 10 …”

Section: Introductionmentioning

confidence: 99%

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Pharmacists as members of an interdisciplinary pulmonary embolism response team

Groth

Acquisto

Wright

et al. 2021

J Am Coll Clin Pharm

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Introduction: Pulmonary embolism response teams (PERTs) were developed to assist with diagnosis, risk stratification, and management of intermediate and high-risk pulmonary embolism (PE) and have been shown to reduce 90-day mortality. The pharmacist's role on the PERT is not well defined. Objectives: Describe the pharmacist's role as a PERT member and determine if pharmacists can improve time to anticoagulation and promote use of low molecular weight heparin (LMWH) instead of unfractionated heparin (UFH). Methods: A retrospective, observational study of adult patients with massive or submassive PE between January 2014 and May 2020. Patient demographics, clinical variables, anticoagulation treatment/timing, and pharmacist activities during PERT response were evaluated. Patients were divided into three groups for comparisons (pre-PERT vs post-PERT with a pharmacist vs post-PERT without a pharmacist). Wilcoxon rank-sum or Kruskal-Wallis test and chi-squared analysis were used for continuous and categorical data, respectively. Results: A total of 573 patients were included (mean age 63.2 ± 15.6 years, 54% male, 78% submassive PE); 137 in the pre-PERT and 436 in the post-PERT groups. Within the post-PERT group, 305 patients (70%) had a pharmacist as a member of the PERT, of which 222 (73%) had a documented pharmacotherapy-related intervention/activity. Most (n = 178, 58%) involved a pharmacist facilitating ordering/ administration of an anticoagulant/thrombolytic. Median time from diagnosis to anticoagulation was significantly reduced in the post-PERT groups (pre-PERT: 104 minutes [IQR 124.5], post-PERT with a pharmacist: 63 minutes [IQR 84], post-PERT without a pharmacist: 75.5 minutes [IQR 113], P = .0001). More patients in the post-PERT groups received LMWH compared to UFH when a pharmacist was involved vs without a pharmacist (69.5% vs 53.3%, P = .0019) and major bleeding events were reduced

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pharmacists as members of an interdisciplinary pulmonary embolism response team

Groth

Acquisto

Wright

et al. 2021

J Am Coll Clin Pharm

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“…The participating rate of each specialty is presented in Fig. 2, [5,15,16,18,19,21,23,27,29,31,[33][34][35]. A single pager number, a dedicated phone line, or an alert via the electronic medical system were the tools for PERT activation across studies.…”

Section: Composition and Operation Of Pertsmentioning

confidence: 99%

Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis

et al. 2022

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Background Over the last years, multidisciplinary pulmonary embolism response teams (PERTs) have emerged to encounter the increasing variety and complexity in the management of acute pulmonary embolism (PE). We aimed to systematically investigate the composition and added clinical value of PERTs. Methods We searched PubMed, CENTRAL and Web of Science until January 2022 for articles designed to describe the structure and function of PERTs. We performed a random-effects meta-analysis of controlled studies (PERT vs. pre-PERT era) to investigate the impact of PERTs on clinical outcomes and advanced therapies use. Results We included 22 original studies and four surveys. Overall, 31.5% of patients with PE were evaluated by PERT referred mostly by emergency departments (59.4%). In 11 single-arm studies (1532 intermediate-risk and high-risk patients evaluated by PERT) mortality rate was 10%, bleeding rate 9% and length of stay 7.3 days [95% confidence interval (CI) 5.7–8.9]. In nine controlled studies there was no difference in mortality [risk ratio (RR) 0.89, 95% CI 0.67–1.19] by comparing pre-PERT with PERT era. When analysing patients with intermediate or high-risk class only, the effect estimate for mortality tended to be lower for patients treated in the PERT era compared to those treated in the pre-PERT era (RR 0.71, 95% CI 0.45–1.12). The use of advanced therapies was higher (RR 2.67, 95% CI 1.29–5.50) and the in-hospital stay shorter (mean difference − 1.6 days) in PERT era compared to pre-PERT era. Conclusions PERT implementation led to greater use of advanced therapies and shorter in-hospital stay. Our meta-analysis did not show a survival benefit in patients with PE since PERT implementation. Large prospective studies are needed to further explore the impact of PERTs on clinical outcomes. Registration Open Science Framework 10.17605/OSF.IO/SBFK9. Graphical abstract

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VA‐ECMO‐assisted aspiration thrombectomy in a patient presenting with acute massive PE with absolute contraindications to thrombolytics

Patel

Mujer

John

et al. 2022

Cathet Cardio Intervent

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Massive pulmonary embolism (PE) is a life‐threatening complication of major surgery with a mortality rate up to 50%. First‐line therapy for massive PE is systemic thrombolytics, but surgical patients are at high bleeding risk with absolute contraindications. As surgical thrombectomy carries a high burden of morbidity and mortality, endovascular interventions are becoming more common in these clinical scenarios. We report a case of a neurosurgical patient whose postoperative course was complicated by massive PE and subsequent cardiac arrest that required emergent venoarterial extracorporeal membrane oxygenation, followed by aspiration thrombectomy with the Inari FlowTriever Device (Inari Medical). The patient had immediate hemodynamic improvement with eventual recovery to baseline functional status.

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Effect of a Multidisciplinary Pulmonary Embolism Response Team on Patient Mortality

Cited by 40 publications

References 16 publications

Pharmacists as members of an interdisciplinary pulmonary embolism response team

Pharmacists as members of an interdisciplinary pulmonary embolism response team

Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis

VA‐ECMO‐assisted aspiration thrombectomy in a patient presenting with acute massive PE with absolute contraindications to thrombolytics

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