How To Build A Pulmonary Embolism Response Team (PERT)

[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.