Hello from the Communications Committee!
We are excited to introduce our Spotlight on a PERT series with a focus on the Weill Cornell program in New York, NY.
Spotlight is a new initiative from the Communications committee intended to give the Consortium an opportunity to observe how other PERTs function. Start the discussion on twitter (@PERTConsortium) with some insight into how you run your PERT.
Please let us know if you’d like to be next (or if you have other ideas for questions)!
James Horowitz, MD FACC
Division of Cardiology
New York Presbyterian – Weill Cornell Medicine
Key members in their PERT include:
Pulmonary Critical Care: Lindsay Lief, Meredith Turetz
Interventional Radiology: Ron Winokur
Cardiothoracic Surgery: Arash Salemi
Cardiology: James Horowitz
How long has your institution had a PERT?
We got our start in 2012. We had a young man with a massive PE after meningioma resection who was obviously very complex. Several specialties were called to take care of him (and he did great, see http://bit.ly/2bP0i6I), so afterwards we decided to “make it official” and form a team.
Who participates on the PERT team?
Our primary team consists of Pulmonary/Critical Care, Cardiology, Interventional Radiology and Cardiac Surgery. Heart failure and hematology are also invested, but are only involved when needed on a case by case basis.
How it the team activated?
We have a 24/7 pager number 12568, or 1CLOT. Pulmonary/Critical Care receives the pages and is the first line consultant. They then activate the rest of the team when needed for submassive or massive PE. I also receive all the pages on my personal pager, which was important when we first got started to make sure things were working smoothly and consistently. I can also track our consults in this manner.
How does the team communicate?
We mostly communicate by phone and text, and almost always meet in person for the sicker patients or those who go on to procedures. We are also very excited that our hospital recently rolled out dedicated iPhones with proprietary software that links to our EMR and allows team-based text messaging.
What improvements have you seen in patient care with the introduction of the PERT concept?
Perhaps most important to the PERT concept is the end of serial consults. PE patients are potentially too unstable to wait for the primary team to consult pulmonary, then cardiology for an echo, then perhaps IR or the cath lab for an intervention. Time is of the essence when your RV is unstable so PERT provides “one stop shopping.”
Secondly, even if your team doesn’t recommend an intervention (and most of the time we actually don’t) we often triage patients to a higher level of care such as step down or ICU. Often it’s that higher level of nursing care than can be life saving if a patient decompensates.
How do you see your team evolving in the future?
We are excited to welcome new attendings from each of our specialties to our PE team; adding new blood is key to keep reinvigorating our process. We are also very interested in some of the newer devices out there for PE work such as AngioVac, Flowtriever and Penumbra. It’s unclear whether clot extraction or CDT will be the mainstay of therapy in the future, so it’s an amazing time to be in the field.
What advice would you give to a new hospital looking to start a PERT?
Choose your team wisely. Any number of specialties can be your first-line consultant or your proceduralist, so it’s important to choose those who will be good team players and provide a consistent 24/7 response. If calls go unanswered or referring providers feel like they’re not getting “good service” the team will fall apart quickly.