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Effects of Implementing a Standardized Risk Stratification and Triage Workflow for an Established Pulmonary Embolism Response Team.

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Titel: Effects of Implementing a Standardized Risk Stratification and Triage Workflow for an Established Pulmonary Embolism Response Team.
Autoren: Hassan HJ; Department of Medicine., Belecanech RG; Division of Pulmonary & Critical Care Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania., Leary PJ; Division of Pulmonary & Critical Care Medicine and Department of Epidemiology, University of Washington, Seattle, Washington; and., Lyons GR; Division of Interventional Radiology., Weiss CR; Division of Interventional Radiology., Yui JC; Division of Hematology., Aziz H; Division of Cardiothoracic Surgery, and., Kim BS; Department of Surgery and Perioperative Care, University of Texas at Austin, Austin, Texas., Hager DN; Division of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland., Kolb TM; Division of Pulmonary & Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
Quelle: Annals of the American Thoracic Society [Ann Am Thorac Soc] 2025 Oct; Vol. 22 (10), pp. 1484-1492.
Publikationsart: Journal Article
Sprache: English
Info zur Zeitschrift: Publisher: American Thoracic Society Country of Publication: United States NLM ID: 101600811 Publication Model: Print Cited Medium: Internet ISSN: 2325-6621 (Electronic) Linking ISSN: 23256621 NLM ISO Abbreviation: Ann Am Thorac Soc Subsets: MEDLINE
Imprint Name(s): Original Publication: New York, NY : American Thoracic Society, [2013]-
MeSH-Schlagworte: Pulmonary Embolism*/therapy , Pulmonary Embolism*/mortality , Pulmonary Embolism*/diagnosis , Triage*/standards , Triage*/methods , Workflow*, Humans ; Female ; Male ; Risk Assessment/methods ; Hospital Mortality ; Quality Improvement ; Middle Aged ; Aged ; Retrospective Studies ; Academic Medical Centers ; Intensive Care Units ; Logistic Models
Abstract: Rationale: The pulmonary embolism response team (PERT) model was developed to facilitate multispecialty decision-making and expedite therapeutic interventions for patients with pulmonary embolism (PE). PERT implementation has previously been associated with survival benefit in some studies, although specific workflow components that confer survival benefit have not been identified. Objectives: To measure the effects of PERT workflow revisions based upon risk stratification on clinical outcomes in an existing PERT. Methods: As a quality improvement initiative, we implemented three specific workflow interventions to an existing PERT program at an academic medical center: 1 ) designating triage responsibility to a specific group of providers; 2 ) assigning guideline-based risk stratification to all calls at triage; and 3 ) establishing intensive care unit admission guidelines on the basis of risk stratification. We used electronic medical records to review clinical outcomes for all PERT calls for 2 years after implementing the revised workflow and compared these with outcomes for the preceding 2-year period. We used logistic regression to compare the odds of in-hospital mortality before and after the workflow revision, with multiple models adjusted for clinically relevant variables. Results: During the study period (2019-2023), there were 420 unique patient PERT activations with confirmed PE; 253 patients were managed using the revised workflow, and 167 patients were managed using the historical workflow. The proportion of patients meeting the primary endpoint of in-hospital death at 30 days after the workflow revisions was significantly lower than during the historical period (6.3% vs. 18.0%; P  < 0.001). Logistic regression analysis demonstrated the revised-PERT workflow to have a protective effect against in-hospital mortality (odds ratio = 0.31; 95% confidence interval = 0.16-0.59; P  < 0.001). This mortality benefit remained significant after adjustment for demographics, clinical factors, hemodynamic instability, Pulmonary Embolism Severity Index class, and stage in the Bova scoring system. The workflow revisions were also associated with increased use of advanced therapies but did not change the proportion of patients with major bleeding or length of stay in the intensive care unit or hospital. Conclusions: In an existing PERT program, implementation of three specific workflow revisions centered around risk stratification and level-of-care triage improved survival for patients with PE. These findings suggest that incorporation of a standardized approach and risk stratification are valuable components of the PERT response.
Grant Information: F32 HL154672 United States HL NHLBI NIH HHS; F32 HL154672 United States NH NIH HHS
Contributed Indexing: Keywords: hospital mortality; pulmonary embolism; workflow
Entry Date(s): Date Created: 20250509 Date Completed: 20251001 Latest Revision: 20251008
Update Code: 20251008
PubMed Central ID: PMC12499878
DOI: 10.1513/AnnalsATS.202412-1301OC
PMID: 40344158
Datenbank: MEDLINE
Beschreibung
Abstract:Rationale: The pulmonary embolism response team (PERT) model was developed to facilitate multispecialty decision-making and expedite therapeutic interventions for patients with pulmonary embolism (PE). PERT implementation has previously been associated with survival benefit in some studies, although specific workflow components that confer survival benefit have not been identified. Objectives: To measure the effects of PERT workflow revisions based upon risk stratification on clinical outcomes in an existing PERT. Methods: As a quality improvement initiative, we implemented three specific workflow interventions to an existing PERT program at an academic medical center: 1 ) designating triage responsibility to a specific group of providers; 2 ) assigning guideline-based risk stratification to all calls at triage; and 3 ) establishing intensive care unit admission guidelines on the basis of risk stratification. We used electronic medical records to review clinical outcomes for all PERT calls for 2 years after implementing the revised workflow and compared these with outcomes for the preceding 2-year period. We used logistic regression to compare the odds of in-hospital mortality before and after the workflow revision, with multiple models adjusted for clinically relevant variables. Results: During the study period (2019-2023), there were 420 unique patient PERT activations with confirmed PE; 253 patients were managed using the revised workflow, and 167 patients were managed using the historical workflow. The proportion of patients meeting the primary endpoint of in-hospital death at 30 days after the workflow revisions was significantly lower than during the historical period (6.3% vs. 18.0%; P  &lt; 0.001). Logistic regression analysis demonstrated the revised-PERT workflow to have a protective effect against in-hospital mortality (odds ratio = 0.31; 95% confidence interval = 0.16-0.59; P  &lt; 0.001). This mortality benefit remained significant after adjustment for demographics, clinical factors, hemodynamic instability, Pulmonary Embolism Severity Index class, and stage in the Bova scoring system. The workflow revisions were also associated with increased use of advanced therapies but did not change the proportion of patients with major bleeding or length of stay in the intensive care unit or hospital. Conclusions: In an existing PERT program, implementation of three specific workflow revisions centered around risk stratification and level-of-care triage improved survival for patients with PE. These findings suggest that incorporation of a standardized approach and risk stratification are valuable components of the PERT response.
ISSN:2325-6621
DOI:10.1513/AnnalsATS.202412-1301OC