The Massachusetts General Hospital Pulmonary Embolism Response Team (MGH PERT): Creation of a Multidisciplinary Program to Improve Care of Patients With Massive and Submassive Pulmonary Embolism

Abstract

New and innovative tools have emerged for the treatment of massive and submassive pulmonary embolism (PE). These novel treatments, when considered alongside existing therapy, such as anticoagulation, systemic intravenous thrombolysis, and open surgical pulmonary embolectomy, have the potential to improve patient outcomes. However, data comparing different treatment modalities are sparse, and guidelines provide only general advice for their use. Treatment decisions rest on clinician expertise and institutional resources. Because various medical and surgical specialties offer different perspectives and expertise, a multidisciplinary approach to patients with massive and submassive PE is required. To address this need, we created a novel multidisciplinary program - the Massachusetts General Hospital (MGH) Pulmonary Embolism Response Team (PERT) - which brings together multiple specialists to rapidly evaluate intermediate- and high-risk patients with PE, formulate a treatment plan, and mobilize the necessary resources to provide the highest level of care. Development of a clinical, educational, and research infrastructure, as well as the creation of a national PERT consortium, will make our experience available to other institutions and serve as a platform for future studies to improve the care of complex patients with massive and submassive PE.

Multidisciplinary Pulmonary Embolism Response Teams

“…Such recommendations are supported primarily by expert opinion and case series. 4 The fact that some PEs mandate urgent intervention compounds these problems. An additional challenge is that multiple specialties may diagnose PE, includ- …”

“…4 next, PERT faculty and the referring clinician are alerted to log onto a real-time multispecialty discussion held as a virtual meeting using commercially available software (www.gotomeeting.com); in this password-protected environment, the case is presented, and imaging data are simultaneously reviewed by the PERT faculty. Echocardiography and radiology specialists join the conference to provide expert, real-time imaging interpretation and insights.…”

“…This acute response to an individual patient is supported by a longitudinal infrastructure of core leadership and administrative faculty, data collection, and process improvement. 4 An intramural educational campaign consisting of Grand Rounds seminars, presentations at House Staff didactic conferences, cross-training with existing hospital rapid response systems and nursing supervisors, and distributing color posters on inpatient floors preceded the program launch. The process of accessing the PERT specialists was "democratized" 13 so that any clinician caring for a patient with a submassive or massive PE could activate the system with a single contact to a central call service.…”

Multidisciplinary pulmonary embolism response teams and systems

“…Many institutions are building pulmonary embolism response teams (PERTs) to bring together specialists to discuss their expert consensus opinions about the intricacies of challenging PE cases (2)(3)(4). PERTs develop in many different forms to take advantage of locally available resources and suit local clinical demands.…”

Clinical significance and management of right heart thrombi: more questions than answers

“…Until results from other studies provide more evidence-based guidance, patients with RHT, especially those deemed at high risk for adverse outcomes, should undergo cautious monitoring and individualised treatment. A multidisciplinary Pulmonary Embolism Response Team (PERT) [16] that rapidly evaluates patients, formulates a treatment plan, and mobilises the necessary resources may assist with this endeavour.…”