BackTable Article

How To Build A Pulmonary Embolism Response Team (PERT)

Quynh-Anh Dang • Aug 25, 2021

Dr. Eric Secesmsky describes the formation and coordination of his Pulmonary Embolism Response Team (PERT). He describes factors that can make these teams successful, including multidisciplinary mindset, clear communication channels, and effective use of technology.

We’ve provided the highlight reel in this article, but you can listen to the full podcast below.

The BackTable Brief

• Multidisciplinary collaboration was a crucial foundation for building the first pulmonary embolism response team.

• Dr. Secemsky describes the initial steps in his current PE communication pathway, which involves a designated PE pager, echocardiogram, lab work, and consults with cardiology and vascular medicine.

• Web-based HIPAA-compliant platforms allow team members to stay updated with imaging and give their treatment recommendations.

Table of Contents

Building a Pulmonary Embolism Response Team

Effective Communication Within a Pulmonary Embolism Response Team

Pulmonary embolism response team meeting to discuss an acute pulmonary embolism case

Building a Pulmonary Embolism Response Team

Dr. Secemsky describes the formation of his first Pulmonary Embolism Response Team (PERT). He emphasizes that the multidisciplinary structure was a large factor in its success because it pooled together expertise from different specialties to make treatment decisions.

[Dr. Sabeen Dhand]
You were part of the development of a pulmonary embolism response team at Massachusetts General Hospital. Can you describe how the PERT functioned there?

[Dr. Eric Secemsky]
It's 2021 and most hospitals can now manage all flavors of PE. When this team was starting at our hospital at Mass General in 2012, a multidisciplinary group of people came together and said, “No one is owning this condition, yet it's incredibly morbid and fatal. These patients come to the hospital and no one knows what is the right decision. At the same time, more and more therapies are becoming available. So, why don't we approach this in a multidisciplinary way, using whatever evidence is available, to make our best clinically-informed decisions?”

I think it really was a unique approach. If we had started the field of coronary intervention with the cardiac surgeons as partners, we would be in a better place. Maybe in peripheral vascular disease, if we had started this in collaboration with vascular surgeons and interventional radiologists, all of us managing patients together and making treatment decisions together, we would all work together a little bit better. I think it was special to start the PERT in a multidisciplinary way because these PE patients were treated by all disciplines: interventional radiology, hematology, pulmonology, cardiac surgery and cardiology. It was a special time for a new paradigm for treating a disease that's been around.

Effective Communication Within a Pulmonary Embolism Response Team

At Dr. Secemsky’s current institution, the PERT has clear communication channels that can reach a diverse group of specialists at any time of day. Additionally, the use of web-based HIPAA-compliant apps facilitate rapid information sharing and ensures that all team members can be involved in the care and give recommendations over pulmonary embolism interventions.

[Dr. Sabeen Dhand]
Let’s say a patient comes into the ER with this intermediate high risk PE, they are unable to complete sentences, and they are on a non-rebreather. Who gets called? How does the PERT team work at your current institution?

[Dr. Eric Secemsky]
At Beth Israel, we call ourselves the MASCOT team, but it's a PE team. We have a specific pager for any pulmonary embolism. Almost like the ST Elevation MI (STEMI) pager that we have for coronary. If a sick patient comes into the Emergency Room, they page the PE pager, and that goes to our 24/7 wonderful on-call cardiology fellow. We always have a vascular medicine attending overseeing that fellow, usually not in the hospital, but on-call. My partners or I will usually take that call.

The fellow will be down there, get the information, get the CT scan pulled up and sent out to the group, get an echocardiogram if they can, and get some of that lab work. Then, they'll have an initial discussion with the vascular medicine attending who is on call. When there is any concern or question about whether we need to advance therapy outside of anticoagulation, so pretty much any intermediate high risk PE, we will have a phone call. We have a text-based, HIPAA-compliant app that goes out to a group of about 20 people. These are pulmonologists, hematologists, cardiologists, interventional cardiologists, cardiac surgeons, vascular medicine, and critical care. So, it’s a really diverse group. It doesn't matter what time of day.

On the app, we will be able to look at and to share HIPAA-compliant pictures of the echocardiogram. We will get the medical record number through an email to look up the CT scan, and then we will have a conversation. The fellow will lead that conversation and say "Here's the clinical data, here's my exam, here's the imaging, and the lab results, and this is my empiric thought and what I think we should do." And we go around and everybody gives their opinion.

It's usually about a 15 minute phone call and on a busy week, we’d do about three or four, maybe five at most. We try to reserve the calls for cases where we need to make a clinical decision such as escalating to an advanced therapy. I think everybody feels like they share the responsibility of the patient and the decision. When we make a decision, especially for us on the vascular medicine side, a lot of the notes come in our name. We feel like we're representing the group and an informed decision that we feel comfortable with.

[Dr. Sabeen Dhand]
It's neat that you incorporate technology because that ability to share information with everyone at the same time really increases your efficiency. Is this a PE-specific platform or are you using a normal HIPAA compliant platform and tailoring it to your use?

[Dr. Eric Secemsky]
This is nothing fancy. This is just a HIPAA-compliant platform. It's web-based, so you can pretty much pull up images wherever you are, even on your phone. Usually we're all really close, even across specialties, so we text each other if we need to.

[Dr. Sabeen Dhand]
That's great. It's great that you have communication between all the teams, because there's a lot of people involved and if you're calling each one separately, that takes a lot of time. You guys are really using technology to your advantage.

BackTable Podcast advice from your endovascular peers mobile banner
BackTable Podcast advice from your endovascular peers desktop banner

Podcast Contributors

Dr. Eric Secemsky

Dr. Eric A. Secemsky, MD, MSc, RPVI, FACC, FSCAI, FSVM is the Director of Vascular Intervention and an Interventional Cardiologist within the CardioVascular Institute at Beth Israel Deaconess Medical Center (BIDMC).

Dr. Sabeen Dhand

Host Dr. Sabeen Dhand is a practicing interventional radiologist with PIH Health in Los Angeles.

Cite This Podcast

BackTable, LLC (Producer). (2021, April 12). Ep. 120 – Pulmonary Embolization Interventions & Response Teams [Audio podcast]. Retrieved from https://www.backtable.com/podcasts

Medical Disclaimer

The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.