Learn what DVT and PE are and what your healthcare professionals may be doing to help you.
Hello. I’m Dr. Rachel Rosovsky. I’m Dr. Geoffrey Barnes. I’m Dr. Geno Merli. And I’m Dr. Belinda Rivera-Lebron.
Dr. Geoffrey Barnes: You’re probably watching this video because you’ve had a blood clot event called a deep vein thrombosis, or DVT, or you’ve had a pulmonary embolism, or PE.
Dr. Belinda Rivera-Lebron: You may be scared or confused, and that’s okay. They’re serious events and can be very unexpected. And you’re not alone – up to 900,000 occur in the U.S. each year.
Dr. Geno Merli: But you should also know there are treatments for these conditions, and the healthcare providers around you are here to help and support you!
Dr. Rachel Rosovsky: We’re here from the PERT Consortium – which stands for pulmonary embolism response team – or PERT, for short. PERT’s mission is to continually educate patients and healthcare providers and improve blood clot treatment.
Dr. Geno Merli: This short video series will help you understand what blood clots are, and how they’re treated, and how you can help prevent another event from happening again. I’ll be taking you through this first video. And my colleagues will be taking you through the following ones.
So what is a deep vein thrombosis (DVT) or a pulmonary embolism (PE)?
Deep Vein Thrombosis, or DVT, is a blood clot in a vein – most often in the legs. This clot can break off, travel through your blood stream, and enter a lung and cause life-threatening damage – and that’s known as a pulmonary embolism, or PE. DVT and PEs are closely linked conditions, so you may hear your healthcare team talk about them together.
There are risk factors for blood clots like certain medical conditions that affect blood clotting – surgery, multiple days in the hospital, birth control pills, sitting for long periods of time, cancer, obesity, and more – so talk to your healthcare team about them. Many times it may be clear what has caused a DVT, but sometimes it’s not understood why the DVT happened at all – and PEs can happen without any evidence of a DVT, too.
There are risks you should be aware of. A blood clot, like a DVT or PE, can threaten your life. And once a DVT or PE has happened, you’re at higher risk of having another – especially in the time period immediately after. They are serious events and that’s why you may need treatment to help prevent another event occurring again.
There are different treatments available, and you may have already been started on one – most likely an anticoagulant, sometimes called a “blood thinner.” Common blood thinner options include: oral medications, such as warfarin or direct oral anticoagulants, or certain injections.
Anticoagulants, or blood thinners, make it so that your blood can’t clot as easily, to help prevent clots from forming or getting bigger.
Among these medications, direct oral anticoagulants, better known as DOACs, may be prescribed in place of others because they have no dietary restrictions, don’t require routine monitoring, and don’t require injections.
Oral blood thinners like warfarin and intravenous or injectable blood thinners also help stop a blood clot from growing larger and help prevent other blood clots from forming.
Your healthcare provider may put you on injections prior to oral therapy. If you’re prescribed warfarin, you may require some routine monitoring and food restrictions.
Whatever blood thinner you’re on, your healthcare team can tell you about it and you should follow the treatment plan they’ve made.
Clotting is the body’s natural way to stop bleeding.
Because blood thinners help prevent blood from clotting, your healthcare team will tell you to be more careful when doing certain activities that could lead to bruising and bleeding, and will go over any possible side effects and interactions with other medications or supplements you’re taking.
Ask your healthcare provider if anticoagulants are considered a safe and effective treatment for you. Studies have shown they could help lower the chance of another blood clot happening. There are risks associated with anticoagulant therapy. So, make sure to ask your healthcare team if it’s right for you.
Your healthcare team is here to help.
A DVT usually starts in the legs.
A PE can happen when a blood clot travels to the lungs.
All blood thinners come with a risk of bleeding. Ask your healthcare team which blood thinner may be right for you.
Now that you understand a little more about DVT and PE blood clots and what’s being done to help treat and reduce your risk of a repeat event, you can watch another video with Dr. Rachel Rosovsky about very important things to know before you go home. You can watch it now – but make sure you watch it again before you leave!
GETTING READY TO GO HOME
Watch a video on simple tasks you can do before you leave the hospital to keep your treatment on track.
Hello, I’m Dr. Rachel Rosovsky. Welcome back! We hope you’re recovering well from your condition and are looking forward to going home.
Before you do, though, there are important things you should know—and things you can do—to help keep your treatment for DVT or PE on track.
#1: Your prescription
You were likely given medicine for DVT or PE to take home or you were prescribed it. Make sure you fill your prescription if you weren’t given it in the hospital and always take your medication as directed.
If you weren’t prescribed medication, have a conversation with your healthcare provider about whether you should be taking medicine to help reduce the risk of another blood clot.
If you’re in the hospital, and haven’t filled your prescription, many hospitals have a pharmacy and it’s best to fill your prescription right away. Or, if you’re at a healthcare provider’s office or clinic, make sure you go to the pharmacy on the way home if possible.
Also, more and more pharmacies have online websites and apps where you can fill your prescription and have it delivered right to your home.
Make sure you understand the dosing: How much, when to start, and how often. If you have questions or don’t understand anything, just ask! Above all—don’t stop taking your medication without talking to your healthcare team.
Your prescription may only cover 30 days, but your treatment may be longer.
It’s important you make a follow-up visit with your primary care physician or specialist to discuss your health and medication—how to fill it and take as directed.
Please follow up with your healthcare team about the details of your medication refill moving forward and the treatment plan you should follow.
Remember: it is really important to fill your prescriptions, understand your treatment, and take your medication as directed—the risks and dangers of another blood clot are real. Talk to your healthcare team if you have any questions!
#2: Make sure to discuss your treatment moving forward with your healthcare provider.
There are so many reasons it’s important to set up an appointment with your healthcare team after you first get treated. Set up a follow-up appointment if one has not been arranged for you—do it before you leave.
Follow-up treatment plans will depend on the person. You should discuss dosage changes, ongoing treatment, and, depending on how serious your condition is, your healthcare team may recommend lifestyle changes and treatment steps you may need.
Whatever your healthcare team’s advice is, take an interest in your condition and follow your treatment plan.
#3 Help is available!
You may have questions or concerns as time goes on. Make sure you have your healthcare team’s contact number so you can reach out.
There may be affordability and co-pay options available to help with medication costs. Talk to your healthcare team and check your medication’s website.
There are many educational and support resources online and in your community for people who have gone through exactly what you have.
Remember 1, 2, 3 before you leave:
1. Fill your prescription at the hospital, on the way home, or online for delivery.
2. Set up—and keep—your follow-up appointment with your healthcare team, and learn and follow your treatment plan.
3. Ask about cost, treatment, and emotional support concerns with your healthcare team, online, and in your community.
You can watch the next video now—but be sure to watch it again when you get home. If you’re watching this on your phone or a tablet, click here to enter your email to be sure you get the next two important videos and a reminder checklist.
Learn more about ongoing treatment—including what you should do and what not to do.
Hi, I’m Dr. Geoffrey Barnes. Welcome home! We’re sure it’s a relief. Now let’s get right to it and talk about some important information to help you with your DVT or PE.
You may have gotten a temporary supply of medication for the treatment of your blood clot, but have you filled your prescription to make sure you have enough—and made your follow-up appointment with your healthcare provider? It’s very important!
If you haven’t filled your prescription and made a follow-up appointment with your doctor, do it now!
It’s important to remember: once a blood clot like a deep vein thrombosis (a DVT) or a pulmonary embolism (a PE) happens, you are at higher risk of having another, so it’s very important to stay on your treatment as advised by your healthcare provider.
Some people need to take an anticoagulant for 3-6 months and some people may need to take it even longer.
Some ongoing risk factors for developing another blood clot, like cancer, require ongoing treatment; other risk factors, like surgery or being hospitalized for more than a few days, may require treatment for a shorter period of time. So talk with your healthcare provider about the right treatment for you.
Remember: while taking a blood thinner medication, or an anticoagulant, you are at higher risk of bleeding and are likely to bruise more easily. It also may take longer for bleeding to stop. You may have a higher risk of bleeding if you have certain other medical problems.
Also, you should not make a sudden decision to stop taking your medication on your own. Talk to your healthcare provider and do not stop taking the blood thinner until they’ve given you their advice.
If you are running out of your medication, reach out to your healthcare provider at least a week before you will run out. Continue to keep taking your medicine as directed by your healthcare provider.
If you and your healthcare provider have decided ongoing treatment is right for you—take your medication regularly and follow the plan.
Remember, for many people, the reason they are at risk of a blood clot does not go away, so the risk of another clot does not go away. And risk increases over time—and can be life threatening.
BUT—thankfully medications, a healthy lifestyle, and understanding your condition may be effective at helping to prevent another event.
Now, let’s take a little quiz to help you remember some important things:
True or false: Once you’ve had a DVT or PE the risk of another blood clot is over.
Well, that’s false. The risk does not go away and can, in fact, increase.
Okay, a second true or false question: If you cut yourself and it doesn’t stop bleeding, you should immediately stop taking your anticoagulant.
That’s also false. Always talk to your healthcare provider before stopping your treatment. Your anticoagulant has been prescribed to help protect you from another blood clot.
Okay, our last true or false question. I didn’t fill my prescription and make an appointment so it’s too late now.
Absolutely false! It’s never too late to make a positive change for your health. Ask your physician, or talk to an online support group for help sticking to your treatment.
We hope you’ve found these videos helpful. We’ll be in touch!
See you soon.
HOW ARE YOU DOING?
Watch a video on things to keep in mind to help lower the risk of another DVT or PE.
Hello, I’m Dr. Belinda Rivera-Lebron. We hope you’re doing well after a deep vein thrombosis or pulmonary embolism event. Remember, a few important steps can help to lower the risk that a blood clot like a DVT or PE will happen again.
Now that some time has passed, the purpose of this video is to remind us of some important facts.
#1: blood clot risk is ongoing—and once it happens, many people are at high risk of another.
#2: extended treatments to help prevent future blood clots are available and have been proven effective. Make sure to talk to your healthcare provider to assess whether continued treatment is appropriate for you.
And third: help and support from your healthcare team, online resources, and in your community may be available—so reach out!
By now you should have had your follow-up appointment and discussed if ongoing treatment is right for you.
You should have filled your prescription and be regularly taking your medication for as long as directed.
You should also understand the potential risks of anticoagulants—like bleeding and bruising—and any possible interactions from other medications and supplements you may be taking.
It is also very important to remember that you shouldn’t stop taking your medications without talking to your healthcare provider. If you’re having surgery or a procedure, talk to your healthcare provider about what to do about your medication.
If you’re having trouble remembering to take medication or fill a prescription, things like daily pill boxes and medication reminders on your phone can help.
And remember—if you haven’t made your follow-up appointment or filled your prescription, do it right after this video.
Dr. 1: we appreciate the time you’ve spent with us and hope these videos have been worth your attention!
Dr. 2: we believe that if you follow the recommendations shared in these videos, you will help to reduce your chances of having another blood clot.
Dr. 3: we wish you the best. Here is a list of websites you may want to visit or search “DVT and PE” to learn more:
Thank you—we wish you well!
PERT Transitions of Care Podcast
Join Drs. Geoffrey Barnes, Geno Merli, Belinda Rivera-Lebron, and Rachel Rosovsky as they address barriers to successful transitions of care in patients with VTE and discuss possible solutions.
00:00:04 KRISTY: PERT Janssen Transitions of Care podcast, cp-327424 version one.
00:00:11 VOICEOVER: PERTcast, the official PERT Consortium podcast where we feature experts from a wide variety of backgrounds, bringing you the latest and greatest on VTE.
00:00:22 RACHEL ROSOVSKY: Welcome to this podcast, PERT Consortium and Janssen’s Transition of Care podcast. This podcast came out of a collaboration between the PERT Consortium and Janssen Pharmaceuticals, and it’s been a real pleasure to partner with Janssen on this topic of Transitions of Care. We are really excited to have you listening to our podcast.
00:00:42 First, I want to mention a disclaimer. The content in this podcast was created by the featured PERT Consortium speakers. Speakers were paid by PERT Consortium through a sponsorship provided by Janssen Pharmaceuticals. This education content is not certified for continued medical education.
00:00:59 I wanted to introduce our panel of speakers that are going to be leading this podcast. My name is Rachel Rosovsky, and I’m a hematologist at the Massachusetts General Hospital in Boston, Massachusetts and the president-elect for the PERT Consortium. I also run our PERT follow-up clinic. And I am joined today with three other excellent panelists, and I would like each of them to introduce themselves. Geoff, do you want to start?
00:01:24 GEOFFREY BARNES: Hey, Rachel. Thanks so much for having me here. My name is Geoff Barnes. I’m a cardiologist and vascular medicine specialist at the University of Michigan, and I help to direct our PERT program here at Michigan Medicine.
00:01:35 RACHEL ROSOVSKY: Thank you, Geoff. Belinda, would you like to introduce yourself?
00:01:39 BELINDA RIVERA-LEBRON: Hi. I’m Belinda Rivera-Lebron. I am a pulmonary and critical care physician by training, and I am the director for acute and chronic thromboembolism program. That means that I direct our PERT program and I also see most of our patients for follow-up.
00:01:55 RACHEL ROSOVSKY: Wonderful. Thank you for being here, Belinda. And last but certainly not least, Geno.
00:02:01 GENO MERLI: Rachel, thanks for having me. My name is Geno Merli. I’m a professor of vascular medicine at Thomas Jefferson University Hospital and co-director of the Jefferson Vascular Center here in Philadelphia.
00:02:13 RACHEL ROSOVSKY: Well, thank you all so much for being with us today. We’re going to go through and talk about a case and bring each of our expert panelists to help with and think about some of the transitions of care issues.
00:02:26 Before we begin our case, I want to point out that this podcast is a follow-up to the webinar that the PERT Consortium and the Anticoagulation Forum partnered on, and which was presented in April of this year. It’s on the PERT website, pertconsortium.org, if you missed it and want to watch it. It was also focused on transitions of care, and it followed a patient through their diagnosis and transition from intensive care unit to the floor and then rehab and all the issues encountered by that patient each step along the way.
00:02:54 In this podcast, we’re going to focus more on the barriers and challenges that patients experience and providers grapple with at different time points in the transition of care, such as when the patients are getting ready to be discharged from hospital to home. And in addition to those challenges, we’re going to explore and talk about what solutions, tools, and resources are available to providers who are taking care of these patients.
00:03:18 I want to set the stage a bit. Why are we even talking about this issue and having a whole podcast on it? Well, we know transitions of care, which is defined as the movement of patients between healthcare providers or settings, when not effectively completed, can lead to adverse events, higher hospital readmission rates, and even increased healthcare costs. And we also know that anticoagulants, which are the cornerstone of therapy for venous thromboembolism, can be associated with bleeding or even recurrent thrombotic events if patients aren’t given the correct dose or they’re unable to take their drug as prescribed. And medication misunderstanding or errors have been implicated as a leading cause of hospital readmission and visits to the emergency room.
00:04:02 And to highlight how big a problem this is, I want to mention a recent article in JAMA, Journal of American Medical Association, that looked at ED visits to the United States emergency rooms attributed to medication harms. In other words, they asked what were the most frequent medications associated with ER visits for harmful effects, adverse events, attributed to medication use? And this report included over 96,000 cases from 60 nationally representative US emergency departments between the years 2017 and 2019. And the researchers found that the anticoagulants were implicated more than any other class of medication in emergency room visits for medication harms overall and visits involving therapeutic use of medications.
00:04:52 So, as medical providers we are constantly making decisions about anticoagulation, and when we do, we really have to weigh the therapeutic benefit of the anticoagulant against the potential risks, obviously including bleeding. And as a medical community, I think we need to look at the results I just mentioned from this JAMA article and think about what is driving these findings and, in particular, think about the challenges surrounding anticoagulation during transitions of care from both the patient and the provider. And that is really what this podcast is about.
00:05:25 To get us started, I’m going to share a clinical case, which I hope to use to frame our discussion. The patient is a 67-year-old Spanish speaking female who lives alone. She has a history of hypertension, hyperlipidemia. She also has depression and is obese.
00:05:41 She presents with acute shortness of breath, and she’s found to have an intermediate high risk pulmonary embolism. She is immediately and appropriately placed on low-molecular-weight heparin. She is evaluated by the PERT team, who recommends catheter-directed thrombolysis, which she undergoes successfully. She is then placed in the intensive care unit directly after her intervention, and after that, on Day 2, is transferred to the floor. When she’s on the floor, she’s transitioned from the low-molecular-weight heparin to a direct oral anticoagulant, or a DOAC. And on Day 3, she’s ready for discharge.
00:06:15 So, Geoff, I’m going to start with you. When patients are in the hospital and they’re getting ready to be discharged, can you talk about the barriers to patients’ understanding of their disease state, as well as the anticoagulant they’re receiving, and in particular our patient, who is alone, is Spanish speaking, and has a number of other medical issues?
00:06:35 GEOFFREY BARNES: You know, Rachel, this is really a great case to present, because I think it’s one that, as clinicians, we often get excited about. There’s lots of nuances that we have to go through, making decisions, trying to decide what’s the best way to treat this patient. And in doing so, we’re often talking together. We’re getting input from our colleagues. We’re using the data as it evolves to make the best decision.
00:06:58 But those same things can often present as challenges to patients when they’re trying to understand what’s happening. I mean, right off the bat, pulmonary embolism is not nearly as well known as other thrombotic conditions. You know, most people have heard of a heart attack. They’ve heard of a stroke. But it’s much less well known in the general public what a pulmonary embolism or a DVT is, even the words we use, right? DVT, PE, VTE, right, they’re confusing, and do they overlap or what do they mean? Even the colloquial terms like blood clots, those are challenging terms for patients to really understand what they represent.
00:07:38 So, we’re starting off with a public that doesn’t fully understand this disease state to begin with. And then, they’re coming into the hospital, often not feeling very well. They’re pretty sick. There’s lots of different doctors and nurses and pharmacists and everyone coming together to try and help them. But they may not have a single point person. It, you know, it’s a different person in the emergency room versus the one who comes in to evaluate them and says let’s go to the lab for an intervention, which may be a different clinician. And then there’s the ICU team and then the floor team. There’s so much turnover that they may not have that consistent face to really rely on and provide that messaging.
00:08:16 All of those clinicians are doing their best for this patient, and other patients, but they’re busy. There’s not a lot of time to just sit down and really talk with the patient and help to make sure that they understand what’s going on, why this happened, what the treatments are, and what it’s going to look like in the future.
00:08:33 And most patients who come in with a pulmonary embolism, that’s not their only medical condition. They may have other things that we’re trying to manage at the same time. You know, in this case you talked about this patient also having hypertension and hyperlipidemia. I would imagine that the team was talking about some of the blood pressure pills or are the lipids appropriately managed? You know, are we screening for diabetes? Are there other things that are happening here that may sort of just confound the larger picture, which is a challenge?
00:09:01 And when this is happening, this patient started on one medication, a low-molecular-weight heparin, then goes, you know, to have a procedure. She’s in the ICU. Who knows if she stayed on low-molecular-weight heparin or is switched to an unfractionated version? Now we’re moving her back to an oral agent, one of the DOACs, as you describe. That’s a lot of changes, and I’m sure this patient is just trying to keep up with what, what’s happening and what she’s going to go home with.
00:09:25 And we know that patients can feel very overwhelmed, that one of the most powerful tools is having a family member or a caregiver or somebody in the hospital with her. But you told us that she lived alone. Maybe she doesn’t have somebody with her.
00:09:39 And then, add on top of that English is not her first language. She’s primarily a Spanish speaking patient, and in most of the hospitals I’ve worked at, we primarily communicate with our patients in English. And so, we might have to bring in a translator or use one of the phone translators to communicate in Spanish. And so, that’s just adding another barrier on top of this.
00:10:01 And then, of course, the last things is, I think for many of our patients it’s not clear who’s really in charge of that education component, right? Is it the physician team? Is it the pharmacist team? Is there a nurse who’s supposed to come in and do education? Do we have to educate about the disease state versus the medications and who’s owning each piece of it and is that well-coordinated?
00:10:22 So, as you can see, there are lots of barriers for this patient, who’s now getting ready to leave the hospital just a couple days after having a pretty significant pulmonary embolism event, on new medications, having had a procedure performed. I can really see why she may be confused as to everything that’s going on and what she’s going to need to do when she leaves the hospital.
00:10:43 RACHEL ROSOVSKY: Geoff, thank you so much for so eloquently walking us through all those different barriers. And, again, I think this case highlights – highlights many of them. And so, thinking about all those barriers and, in particular, how confusing and challenging this is for patients as she’s ready to walk out the door, my next question is how can we as a medical community and providers for these patients address all those different barriers and challenges you just highlighted?
00:11:12 GEOFFREY BARNES: Well, I think there are a number of strategies we can use to try and make the educational experience for our patients a little bit better. So, right off the bat we know that patients need to hear things multiple times and they need to receive education in multiple formats.
00:11:28 So, obviously, her primary clinical team, so the physicians, nurse practitioners, PAs, they need to spend some time educating her about what’s happening, and they probably need to do that multiple times, you know, each day that she’s in there, making sure they’re going back revisiting and not assuming knowledge, but asking her what’s her level of understanding, what questions she has. Expect those questions. Normalize that.
00:11:54 But giving her written materials or materials in another format can be incredibly powerful. So, whether it’s a piece of paper that maybe is a one-pager about pulmonary embolism and maybe about her treatment and what do blood thinners mean and why is it so important to take them, that’s really important. If you have access to a video that you could play that could help explain what it means to have a pulmonary embolism and walk through that, that can be a really powerful tool.
00:12:20 And, of course, when you provide those, make sure they’re in a language that the patient feels comfortable reading or listening to and understanding. And so, for this patient it’d be really important to have Spanish-specific materials that you could provide for her and give to her.
00:12:36 And then, I think it’s important to have those follow-up elements. And so, not only are you doing that in the hospital, but we need to revisit that when she comes back to clinic. Hey, how are you doing? Now that you’re back home, hopefully you’re feeling better. Do you understand everything that happened? What do you know about your disease state? Tell me about the medicines you’re taking. What challenges are you having? Are you having bleeding or bruising issues? Are you having problems getting the medicine at the pharmacy? How can we help you? We’ve got to ask those questions when patients come back to see us, because we know they’re going to forget so much of the education that happened early on.
00:13:12 And so, I think as clinicians we can dedicate certain people who do those pieces, right? We have our follow-up clinics. Maybe we have somebody on our PERT team who can own that process. We certainly want to make sure we have those resources at arm’s length so we know right where those written materials are or those videos are. And I know we have lots of resources available at the PERT Consortium website that people can go to.
00:13:35 But then, it’s also, I think, helpful to track that. So, let’s look to see how often we’re giving those educational materials. Let’s look to see how often we’re documenting education and who that’s being given by and are they well-trained? So, I think there’s some systematic things that we can do in addition to just doing our best as clinicians for our patients.
00:13:53 RACHEL ROSOVSKY: I think that’s really, really helpful. And I think the thing you mentioned about, the issue that you mentioned about having dedicated people, one of the I think barriers is the time that, you know, you mentioned and how confusing it is for patients and there’s so many people in and out. And you had mentioned nurses and advanced practitioners. And so, can you talk a little bit about how, I mean, again, as a medical community how we could really use all of our staff to kind of hone in on some of those challenges?
00:14:24 GEOFFREY BARNES: Yeah. You brought up a really great example. If your PERT team has access to maybe a nurse practitioner or a clinical nurse specialist who’s really focusing on patients with thrombotic conditions, maybe he or she could spend some time while the patient’s in the hospital talking about the condition, going through a handout. Let’s review the medications and why it’s so important to take that blood thinner so that we don’t have another event. And who to call if you get a nosebleed or you start bruising, right? Going through that can be really helpful.
00:14:55 We can also use our pharmacists. Many hospitals will have a pharmacist come by and do a detailed medication review for anyone going home, whether it’s in general or especially for those going home on anticoagulants, because we know they are those high risk/high reward medications. And so, making sure that pharmacist feels prepared, not just to talk about the DOAC, but also to answer some basic questions about pulmonary embolism, why it may have happened, why the blood thinner is such a good treatment, again, who do you contact if you have questions?
00:15:28 And then, of course, if our nursing staff, you know, who are going through and preparing those discharge papers, they spend a lot of time with patients. We want to make sure they understand what pulmonary embolism is and that the patients are going to have that follow-up and there’s somebody that they can reach out to and talk to. So really, I think there’s multiple different team members that can come together to support patients in this area.
00:15:49 RACHEL ROSOVSKY: Yeah. Well, thank you for sharing all those. And, Belinda, I’d like to move towards you. Can you, in your expert opinion, share what tools and resources that you think currently exist to help the many challenges that Geoff just spoke about? And do you feel like those tools are sufficient and, if not, what else is needed? And, in particular, Geoff mentioned some of those, but how can we get these tools and information into the hands of the providers who are actually taking care of these patients?
00:16:16 BELINDA RIVERA-LEBRON: Thanks for that question. I think it’s such an important topic, because as Geoff was mentioning, we as providers put in a lot of effort in the acute illness and coming up with what’s the right decision and the right treatment for each patient. But sometimes we forget after that treatment has been started, you know, what is the understanding of the patient itself and their retention of when we explain the illness to the patient.
00:16:44 And I cannot tell you how many times I’ve seen patients in clinic that they just say it’s all a blur. “I don’t remember anything of what I’ve been told. I don’t. I don’t know what happened to me.” And it’s not that they were not told about what happened. It’s that they just sometimes in the acute stress environment and all the information that they get provided they may not remember every single detail.
00:17:12 So, I think that, you know, the tools that we have, I think most hospitals nowadays will have some sort of disease-specific information that will be included in their discharge summary, right? So, some on PE specifically. But one of the challenges is that it may be different what I provide in my hospital than what you provide in your hospital. So, it’s not a standardized sort of knowledge that each patient may be receiving, and it may not be updated, as well. Some of it may be, you know, something that’s a year, 10, 15, 20-years-old. And also, the language in which it’s written and may not be necessarily patient-specific, clear, and concise.
00:17:53 So, I think that’s one of the challenges. And I also agree with the fact that multiple providers are giving information, but there isn’t necessarily an ownership of who gives the information. So, maybe the physician assumes that the nurse will be reviewing the information on this chart. Maybe the nurse thinks that the care manager is reviewing the information because they’re approving the medications. And then, the care manager is assuming that the pharmacist may be reviewing the information. Then, we all assume that each other are providing an information and maybe none of us really are connecting and communicating in which information are we supposed to do as part of a team.
00:18:37 I definitely don’t think that what we have is enough. And that’s why we got together and came up with a standardized sort of way that we can provide patient information, not only in a written way but also in a video. And we know that different people respond and have – respond to different ways to get educated and sometimes you need to read it and sometimes you need to see it and hear it.
00:19:06 And that’s why I think that what we came up with and included in our Clot Wise website is so amazing, because it’s a patient-level education and it is in multiple different ways that the patient may get education and it provides a very concise and summarized care from the acute illness to the transitioning and being ready to go home to the follow-up care. And you may be able to review that at your own time.
00:19:39 So, you can see it, if we are able to play it in the hospital or provide you a link that we’ve come up with a QR code that the patient can access from their phone or from their laptop, from their tablets and they can review it with the provider there or they can all, and they can also reach back to it and review it on their own time if they’re in the hospital and also when they’re at home so that they can refresh their memory after the acute stressor is gone. And they are at their comfort of their house that they would be able to reach back and be able to also share that information with their loved ones so that they will be able to come up with questions as they’re getting ready to be followed up in clinic.
00:20:27 RACHEL ROSOVSKY: Well, thank you for sharing all that, and especially for bringing up the Clot Wise videos. I think they’re, again, a great resource for providers to share with their patients. They’re easy to understand and they cover all the important information, all of what we’re just talking about, and kind of address all of those barriers and really help patients understand what just happened to them and what happens as they transition from point-to-point-to-point-to-point.
00:20:51 And I also think what’s really nice about them is, again, they’re easily accessible. But patients can see them in the hospital. So, again, you know, having a medical assistant play the video, give it to a family member, have the QR code. I love that idea. I mean, a lot of people have smartphones. You know, that’s easy and convenient way to provide patients with information.
00:21:11 But it also gives them, once they leave the hospital, and, as you know, they’re so–you even mentioned this–they’re so overwhelmed in the hospital that when they’re home, they can look at it again and again and again and again. And we just heard actually that the Clot Wise videos, which can be printed out in a PDF form, are going to be translated into Spanish. So, for this patient in particular, it’s not going to help her to show her a video because it’s in English. But the fact that it’s going to be now able to be printed out in a PDF form in Spanish is going to be really helpful to address that English is not a – the first language for this patient. So, thank you for sharing all of those.
00:21:48 So, we’ve been talking a lot about patients in the hospital. And, Geno, I want to pivot to the outpatient setting. And let’s say our patient has just been discharged and is now coming to her first post-hospital outpatient appointment. Can you share with us some of the challenges and barriers providers are going to face when that patient shows up and are treated for the first time in that outpatient setting?
00:22:11 GENO MERLI: Well, Rachel, I think that’s a, really a good question for us to address. And I’d like to look at it from the standpoint of the provider who will be actually receiving that patient at discharge, and that provider may not have the expertise for managing pulmonary embolism or may not be comfortable with that management. So, I think that’s a–an important area for us to think about with respect to the receiving provider.
00:22:40 And, secondly, oftentimes these providers, these new providers are not familiar with the patient. And, therefore, they need to get to know them. And trying to get them set up for a 30-minute clinic visit, which is short, to gather that information. And remember, in our patient English was not the first language. So, translator phones may be necessary to help out with that discussion with the patient.
00:23:08 So, here’s our provider getting this new patient. Maybe they don’t know them or maybe they do know them. The clinic visit is a little bit short: 30 minutes. English is not the first language and, therefore, a translator phone, which may utilize more time in order to get information across. And then, our fam-, our patient lived alone and maybe there may not be a family member there or caregiver that would be present so that information could be translated back to the patient.
00:23:39 And sometimes in practices there’s actually video visits that take place, which I think is even more challenging as a barrier for our providers who take on these patients when they’re discharged from the hospital. And, finally, there might be a different health system that the patient may be going to, and readily available information may not be there unless the patient is actually carrying with them that piece of information about what occurred during the hospitalization. So, I think there’s a number of barriers that have to be addressed in receiving a new patient or a known patient to the office practice in the outpatient setting.
00:24:20 RACHEL ROSOVSKY: Thank you for sharing all those different challenges. And I can’t agree with you more. Kind of the lack of information that can be transferred from when the patient is in the hospital to now, to that outpatient setting, even if it’s something you’re familiar with. And, fortunately, sometimes we have mechanisms. But I–I’d love for you to now share with us some of the current and potential solutions that could address these challenges and then, secondarily, how can an institution or an individual go about implementing these solutions?
00:24:53 GENO MERLI: Well, I think, Rachel, the way we can approach this process is, first of all, having dedicated teaching tools. And we just heard Belinda and Geoff mention the translation of this information into Spanish. So that could be utilized as a teaching tool there in the office practice to meet that challenge.
00:25:14 The other aspect is the ability to give a website information after the visit summary. You know, to go to a website to get this kind of information that would help out in better understanding what transpired during that hospitalization. And we did hear about the QR code. I think that’s a very valuable tool that can be utilized for information for not only the provider, but also for the patient and say family members, neighbors that may help out in this situation that we were in.
00:25:47 And also, printing out information at the time of discharge for the patient to take with them, that would be very, very helpful in that second step going to the primary care provider in the community setting. And also, showing the patients on the computer how to access this information. I think that would be very, very important and that would be critical for a physician’s office, for their staff members to be trained and be able to show the patient how to utilize the computer to access material.
00:26:19 And then, the medical assistant playing a video for the physician going into the room, that they would understand this process. And I think this video that’s been created for us for the inpatient side also can be utilized as a refresher for what happened during that hospitalization, and why it’s important to take medication, and why it’s safe to do it in that direction, I think, is very important.
00:26:45 So, these are the few of the things that our institutions that we work at can provide and help us support this aspect. And then, we can implement them into the outpatient setting.
00:26:55 RACHEL ROSOVSKY: I just want to pick up on one point that you made, which is, you know, printing out the materials or showing the patient on the computer. And I think the idea of empowering the patient with as much information and knowledge about their illness and – can help address some of these. Can you speak a little bit about how we as medical providers could do that for our patients?
00:27:17 GENO MERLI: Yes. I think by empowering patients to understand what had happened to them, the disease entity, in this case pulmonary embolism, the medications that they are taking that is very critical for the treatment of the pulmonary embolism is very important. And also, understanding that the medicine’s important to not miss or take extra doses of the medicine and contacting someone when that should occur to avoid a bleeding complication that can occur because of the medication. So, I think it’s important that we as providers empower the patient as much as possible with information for them to better understand their process and what’s going on in terms of their care.
00:28:03 RACHEL ROSOVSKY: Thank you for sharing that. So, let’s think about this patient a little bit differently. What if she wasn’t hospitalized at all? Let’s say she had a low-risk PE and met criteria for home treatment. Do you feel the same challenges that Geoff and Belinda highlighted for her being in the inpatient exist in that scenario? And, if not, what are the additional challenges we might see in patients that, again, are not hospitalized, but are treated in the outpatient setting? And then, what additional solutions do we need and what resources and guidelines are available for providers who are treating these patients, again, those that are not hospitalized for their pulmonary embolism but are well enough to be treated in the outpatient setting?
00:28:47 GENO MERLI: Well, first of all, I think the initial emergency room visit and this patient being, not being admitted but being discharged directly from the emergency room, I think the challenge there is can we get everything across to that patient during that emergency room visit? And remember, it’s a finite period of time for that to be accomplished. So, all the tools that Geoff had mentioned become into play in terms of assessing and caring for this patient who is going to be discharged directly from the emergency room would have to be completed during that emergency room visit time.
00:29:24 So that, that’s going to be important. And then, the second piece is the transition of care, the handoff that would go then to the primary physician to essentially accept that patient and then initiate the second step of the process of care. So, I think it’s sort of compressed and the timing we have to accomplish what we need versus the hospital stay, which would give us a little more time, have more discussion, interaction, and empowerment of the patient. So, I think it’ll be a little more accelerated in terms of getting that patient home. But we can use the same tools that we discussed previously by Geoff and Belinda.
00:30:04 RACHEL ROSOVSKY: And I would there’s, there is another tool that the American College of Emergency Physicians, ACEP, have put out. It’s a low-risk PE point-of-care tool that’s on their website, and it kind of walks providers through on how to identify which patients are safe to go home and then what needs to happen to do that safely. And so, you know, making sure that they have, they understand their anticoagulation, they have drug in hand, that they have a follow-up already in place before they leave the hospital, they know, you know, who and when to call if any issues come up. So, I think you’ve nicely addressed some of those barriers. And I do think that’s a nice tool that providers can become aware of that, again, is a point of care, right, easily accessible.
00:30:49 Well, this has been a great discussion, and I want to thank all the panelists and all the providers listening to the podcast. And to summarize a bit of what we’ve discussed, I really like, Belinda, what you pointed out is really know your patient and what works best for them. I think that’s so important to determine, you know, how are they best going to understand this information? Is it something that’s going to be written? Is it going to be a video? Is it going to be, you know, in a certain language? How many times am I going to have to do it? And then that importance of that teach back to really make sure that patients understand that.
00:31:22 And I think we’ve heard a lot from Geoff, Belinda, and Geno about the different barriers, time being one, lack of expertise, unclear of who the point person is. You know, Geoff, you mentioned that patients see so many different providers. Who is actually taking responsibility for this patient? And then following up in different systems outpatient, especially if you don’t know the patient.
00:31:45 And so, we did talk about all these different barriers and then really focused on solutions, having really dedicated teaching tools. And we’re really fortunate to have the Clot Wise videos. Again, they’re easy to understand and follow. They’re accessible on the PERT website and Janssen website. And now, this PDF is going to be coming out in Spanish. And then having that, you know, a QR code and even providing patients with those written materials.
00:32:10 So, before we end, I just would like to ask each of our panelists to leave one final thought on this topic in terms of what they feel is kind of the most important next steps in tackling this issue of transitions of care. So, Geoff, I’m going to start with you.
00:32:26 GEOFFREY BARNES: I think I would say that we need to build into our systems of care the education component so that it’s routine and it’s not done ad-hoc and that we do it in a way that normalizes questions. So, rather than saying you don’t have questions, say what questions do you have, so we invite those questions and we’re sure patients leave as informed as possible.
00:32:48 RACHEL ROSOVSKY: Thank you. Belinda, how about you?
00:32:50 BELINDA RIVERA-LEBRON: I am going to follow-up on that comment and just say knowledge is power. It’s very important to me as a provider that my patient understands what their disease is, what is the process that they went through and the care that they need, both inpatient and outpatient. And I think as much as possible as you involve them in this knowledge, I think that the ownership that they take, it significantly impacts how much do they–are they able to do for their own care. My comment will be knowledge is power.
00:33:26 RACHEL ROSOVSKY: Thank you. And Geno?
00:33:27 GENO MERLI: Well, I think that knowledge is power is the key point here. I think that on the inpatient side or in the emergency room and directly discharging the patient to home, I think the education about a team approach by the PERT team and that information becomes very important, that education. I think empowerment, as we heard, Rachel, you mention, empowerment of the patient through education is very, very critical. Geoff has highlighted that and Belinda.
00:33:59 And then, finally, paying attention to our primary care providers in the community. As you heard Geoff say, education, education, education is very, very critical to make the providers in the community feel comfortable with this process. And I think they want to have someone available where they can access information to be helpful as they care for patients who have difficult issues.
00:34:23 So, those are the things I highlight. And, once again, the education is the key, key paramount here.
00:34:29 RACHEL ROSOVSKY: So, thank you again. I think transitions of care continues to be a major healthcare issue. And we’ve talked a lot about the barriers and challenges and then some of the resources that can help. And I think this has been a resounding theme that educating providers is key to solving these challenges.
00:34:49 We really hope that this podcast achieved that today. And thank you, again, to all the panelists and to all the people listening today.
Speakers are paid by The PERT Consortium™ through sponsorship funds provided by Janssen.