April 01, 2016 < Back to Categories

Multidisciplinary Pulmonary Embolism Response Teams

David M. Dudzinski and Gregory Piazza

Upon experiencing shortness of breath and chest congestion, a 67 year-old man with no prior medical history was admitted to the hospital with a bilateral, submassive Pulmonary embolism (PE). The emergency medicine department was unsure of the next appropriate measure to take, and as such, activated the hospital’s Pulmonary Embolism Response Team (PERT). Shortly thereafter assembled a team of clinicians from Vascular Medicine, Interventional Cardiology, Cardiothoracic Surgery, Pulmonology, Echocardiography, and Radiology to assess the patient and review his case. Because PE may be diagnosed in a number of departments within the hospital, the sensitivity and complexity of its diagnosis calls for a multidisciplinary approach and is based on two current operational concepts in healthcare: the Heart Team and Rapid Response Teams. These multi-faceted teams have developed in response to a need for streamlined decision-making and treatment guidelines for patients with PE.

The Heart Team concept has derived from a need for cross-specialty collaboration. When evaluating treatment options for a cardiovascular-related diagnosis, the interchange among experts allows for a more thorough strategy and reduces bias. While the Heart Team system values a joint, collaborative effort, the Rapid Response Team functions to prevent cardiopulmonary arrest and death by utilizing a swift a decisive decision-making process. In its conception, the multidisciplinary PERT adopts the foundations of these two systems. A model for other hospitals, the MGH PERT came together to create a team of “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.”

As a result of activating the PERT, the present physicians assessed the patient’s imaging and arrived at a consensus for treatment. A member of the response team briefed the patient, his family, and the emergency department and, together, decided on a treatment option. After his procedure at a 3 month follow-up, the patient was asymptomatic and had a normal-sized, functional right ventricle. The multidisciplinary PERT activation led to a thorough, rapid, and perhaps life-saving result for the patient.

Circulation. January 2016.  DOI:10.1161/CIRCULATIONAHA.115.015086