Radiology as the Impetus for Multidisciplinary Care Team Activation: One Year Analysis After Implementation of a Novel Pulmonary Embolism Response Team.

Pulmonary embolism (PE) is a disease with potentially high morbidity and mortality. Short and long-term outcomes based on time and type of treatment is variable and largely unknown. PE is increasingly managed with multidisciplinary Pulmonary Embolism Response Teams (PERTs). Most current PERTs are activated by the care provider at the time of diagnosis, however, this may result in increased time to appropriate intervention and limit long-term follow-up. We designed a PERT enacted at the time of imaging diagnosis and describe our 1-year experience .

Materials and Methods:

PERT activation occurred at the time of radiographic diagnosis, with the diagnostic radiology (DR) team reading a positive PE on chest CT or V/Q scan. The DR would contact (1) the ordering provider with the findings, as well as (2) the PERT via a group-paging system. The PERT page would include the (1) patient medical record number and (2) RV:LV ratio. The PERT consists of the (1) in-house medical ICU provider, (2) interventional radiology (IR), and (3) interventional cardiology (IC). After review by the ICU team, if warranted, a virtual conference call occurs within 15 minutes to discuss additional management and follow-up . If further workup or interventions are recommended, the ICU team communicates to the primary team to ensure rapid, closed-loop communication of PERT recommendations. The patient is then followed by the appropriate team(s) to monitor for decompensation that could require escalation of care, as well as appropriate long-term follow-up.

Results: From 08/01/2021 to 08/31/2022, the PERT was activated a total of 276 times (35 per month) at our 732-bed academic institution. PERT activation resulted in a multidisciplinary meetings 83 times (7 per month). Of these meetings, a plan of action beyond anticoagulation (surgical intervention, suction thrombectomy, catheter directed thrombolysis) was implemented a total of 34 times (3 per month).

Conclusion:

Our novel, radiology-activated, PERT format has proven to be an effective system for early identification and expedited multidisciplinary management of pulmonary embolism . It furthermore allows local registry data to evaluate follow-up appropriateness, and will allow comparison with artificial intelligence software packages aimed at improving PE patient care. As utilization of multidisciplinary care teams increase, DR and IR are uniquely positioned to synergistically create and lead these teams to improve time to evaluation, treatment, and follow-up of various patient populations.