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Key findings

  • Pulmonary embolism (PE) treatment paradigms have changed little in past 50 years
  • Leadership institutions are pioneering pulmonary embolism response teams (PERTs) to support superior clinical decision-making in the context of growing complexity of PE patients
  • Because practice guidelines may lag clinical reality, the ability to quickly engage experts in a single case conversation may be invaluable to improving patient outcomes

Pulmonary embolism (PE) is a serious, complex and challenging diagnosis whose treatment paradigm has changed little in past 50 years. Its acute nature requires rapid, efficient and correct action. Despite a stable treatment paradigm, new tools and strategies are emerging to leverage its benefits while curtailing devastating complications. Among the emergent approaches is a collaborative practice model involving the formation of pulmonary embolism response teams (PERTs).

The need for urgent, expert intervention increases the role of physician-led consensus decision making in the absence of rigorously-vetted scientific guidelines that take years to formulate. PERT is one way to address this potential decision-making bottleneck, and is being optimized by multidisciplinary PE collaborations at Massachusetts General Hospital.

The Multidisciplinary Advantage

A central strength of the PERT team at Mass General is its multidisciplinary membership. A team includes a broad and diverse suite of clinicians such as vascular medicine and intervention specialists; intensive care unit teams; emergency department teams; cardiologists; pulmonologists; hematologists; radiologists and cardiothoracic surgeons. Subspecialties are involved in workups as needed, such as obstetricians for pregnant PE patients and oncologists for those with cancer.

Supportive Systems

Collaborative infrastructure and tools support the Mass General PERT model, starting with a 24-hour PERT phone number. The goal is to provide swift support for all PERT protocols, and foster rapid, focused and effective communication among clinicians through conference calls, shared imaging and patient data. This highly supported system of expert collaboration enables physicians to reach consensus and make many complex, simultaneous clinical decisions that focus and speed care.

In a field where innovations are rapidly evolving and guidelines for managing them lag, the role of a local “expert opinion” is central and leveraged by a PERT.

Through collaboration, the PERT program offers a level and depth of rapid therapeutic control over myriad clinical variables that is unattainable by a lone expert, yet highly beneficial to the patient. While in its infancy, the PERT model is now being validated. The early results are promising and they suggest applicability for other conditions beyond PE.

Refer a patient to the Fireman Vascular Center

Refer a patient to the Corrigan Minehan Heart Center

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Pulmonary embolism (PE) calls for a coordinated clinical approach. A new paradigm for care for PE was developed at Mass General.

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Kenneth Rosenfield, MD, of Mass General, discusses PERT, an institutionally-based multidisciplinary team that rapidly assesses and treats PE patients.