Assessing the Impact of a Pulmonary Embolism Response Team and Treatment Protocol on Patients Presenting With Acute Pulmonary Embolism
| Autor: | Yen Lin Chee, Jason Phua, Graeme MacLaren, William Kristanto, Pipin Kojodjojo, Kristine Leok-Kheng Teoh, Tiong Beng Sim, Lynette Ls Teo, Joshua Loh, Hwee Seng Yip, Wei-Ying Jen, Ching Ching Ong |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors Treatment protocol Pulmonary angiogram Computed tomography 030204 cardiovascular system & hematology Disease-Free Survival 03 medical and health sciences 0302 clinical medicine Clinical Protocols Intensive care Health care Humans Medicine Thrombolytic Therapy 030212 general & internal medicine Aged Retrospective Studies Adult patients medicine.diagnostic_test business.industry Angiography Middle Aged medicine.disease Pulmonary embolism Survival Rate Right heart Emergency medicine Female Pulmonary Embolism Tomography X-Ray Computed Cardiology and Cardiovascular Medicine business |
| Zdroj: | Heart, Lung and Circulation. 29:345-353 |
| ISSN: | 1443-9506 |
| DOI: | 10.1016/j.hlc.2019.02.190 |
| Popis: | Pulmonary embolism (PE) care has traditionally been fragmented. The newly introduced Pulmonary Embolism Response Team (PERT) model provides streamlined care based on expedient, multi-disciplinary decision-making. This study aimed to quantify the impact of PERT, as part of a hospital-wide PE treatment protocol, on clinical outcomes.Consecutive adult patients with acute PE diagnosed via computed tomography pulmonary angiogram (CTPA) were included. The PERT and treatment protocol were introduced in January 2015. Patient characteristics, therapies, quality measures of CTPA reporting, and clinical outcomes of PE patients treated for 2 years before and after implementation of these changes were evaluated. Primary endpoints were median length of stay in intensive care (ICU) and survival to discharge.A total of 321 consecutive PE patients were enrolled, of which 154 (treated in 2013-2014) and 167 (2015-2016) patients formed the historical control and study groups, respectively. Implementation of the algorithm was associated with less variance in anticoagulation and improved reporting of right heart strain parameters on CTPA. The ICU stay was reduced from a median of 5 to 2 days (p 0.01). Eligible massive PE patients receiving reperfusion increased from 30% to 92% (p = 0.01), with mean delay from diagnosis to reperfusion decreasing from 763 to 181 minutes (p 0.01). Bleeding complications were not increased, but overall survival to discharge remained unchanged.Introducing a PERT and treatment protocol reduced ICU stay, enhanced quality measures, and improved access of massive PE patients to reperfusion therapies, without increasing bleeding complications or health care costs. |
| Databáze: | OpenAIRE |
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