The benefits of a multidisciplinary and standardized approach to pulmonary embolism

Each year, venous thromboembolism (VTE), or a blood clot in the body, affects ~900,000 Americans, resulting in ~100,000 premature deaths^1,2,3. The associated healthcare costs in the U.S. equal ~$10 billion each year¹. Furthermore, pulmonary embolism (PE) can be life-threatening with 10-30% of individuals dying within one month of diagnosis¹, approximately 26% experiencing delays in care, and up to 53% misdiagnosed^4,5. By breaking down silos between medical specialties and embracing newer, more effective treatments, hospitals can take a crucial step toward efficient and patient-centered approaches in the face of PE challenges by creating consistency and consensus.

Why does standardization of care and protocol matter? Consider programs dedicated to the top two leading causes of cardiovascular death globally: ischemic heart disease and stroke⁶. Studies on ST elevated myocardial infarctions (STEMI) and corresponding treatments have demonstrated a significant link between treatment delay and worsening cardiac functional outcomes, with increased mortality⁷. STEMI protocols streamline, standardize, and improve the delivery of care by reducing clinical management uncertainties, improving reperfusion times, and reducing length of stay, adverse outcomes, and mortality⁸. Stroke protocols increase performance of reperfusion therapies with good functional outcomes and improve prognosis after discharge⁹. This begs the question, why not create standardized care paths for the third leading cause of cardiovascular death, PE¹⁰?

Many hospitals worldwide have begun to adopt the use of PE response teams (PERT)^4,11, a multidisciplinary team that addresses these concerns head on. The primary objectives are to standardize care delivery, efficiently identify and risk stratify patients, and provide a roadmap of considerations, including new treatment options¹². A recent study identified the implementation of PERT with decreased cost (cost savings 34.3%), reduction of in hospital mortality (16.5% to 9.6%), median overall length of stay 3 days and ICU stay 1.5 days, notably shorter than in the Pre-PERT analysis¹². By identifying patients suffering from a pulmonary embolism in a streamlined and timely fashion, overall inefficiencies and patient outcomes were improved.

Establishing a PERT

To establish a PERT, the framework and implementation are based on your current available resources with consideration for future growth and development. Identification of a physician champion and program coordinator in the preliminary stages is integral for success. Once key members are identified, protocol building begins.

A PERT may include healthcare providers from both interventional and non-interventional groups such as Pulmonary Medicine, Interventional Cardiology, Hematology, Emergency Medicine, Critical Care, Vascular Medicine, Pharmacy, Cardiothoracic Surgery, and Interventional Radiology¹³. Utilizing a multidisciplinary approach allows a comprehensive plan of care, provides cumulative risk/benefit analysis, and allows patient access to cutting-edge care¹⁴.

Traditional treatments for thrombus, including systemic and catheter-directed lytics, can come with risks and potentially significant complications¹⁵. Recent studies have shown that computer-assisted vacuum thrombectomy (CAVT) like Penumbra’s Lightning Flash^TM, is capable of removing thrombus quickly and has been associated with short hospital lengths of stay, low major adverse events, and good clinical and functional outcomes¹⁶. The Lightning Flash technology uses clot detection algorithms designed to differentiate between thrombus and patent flow with minimal potential blood loss.

PERT has been shown to be a critical component to improving delivery of care and patient outcomes for PE. As such, working across the hospital system to standardize care for PE patients could have a significant impact.

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