Value-based assessment of implementing a Pulmonary Embolism Response Team (PERT)

Annabathula, Rahul; Dugan, Adam; Bhalla, Vikas; Davis, George A.; Smyth, Susan S.; Gupta, Vedant

doi:10.1007/s11239-020-02188-3

Cited by 30 publications

(22 citation statements)

References 15 publications

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“…The searches yielded 2119 citations, 1794 from databases and 325 from grey literature search citations. After duplicates were removed, 1545 studies underwent title and abstract review, after which 22 studies remained [5,6,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Of these studies, six were excluded after reviewing the full-text manuscript.…”

Section: Resultsmentioning

confidence: 99%

“…We included 16 studies [5,6,[12][13][14][15][16][17][18][19][20][21][22][23][24][25] published between 2016 and 2020 and all were single-centre studies from academic institutions. They incorporated patients who were evaluated and treated from August 2012 to April 2020.…”

Section: Descriptive Review and Study Characteristicsmentioning

confidence: 99%

“…Advanced treatment strategies by group : OR corresponds to the subset included in meta-analysis. ¶ : excluding ANNABATHULA et al[12], which combines surgical and catheter-assisted embolectomies. + : total interventions under PERT and control.…”

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confidence: 99%

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Impact of pulmonary embolism response teams on acute pulmonary embolism: a systematic review and meta-analysis

et al. 2022

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BackgroundThe impact of pulmonary embolism response teams (PERTs) on treatment choice and outcomes of patients with acute pulmonary embolism (PE) is still uncertain.ObjectiveTo determine the effect of PERTs in the management and outcomes of patients with PE.MethodsPubMed, Embase, Web of Science, CINAHL, WorldWideScience and MedRxiv were searched for original articles reporting PERT patient outcomes from 2009. Data were analysed using a random effects model.Results16 studies comprising 3827 PERT patients and 3967 controls met inclusion criteria. The PERT group had more patients with intermediate and high-risk PE (66.2%) compared to the control group (48.5%). Meta-analysis demonstrated an increased risk of catheter-directed interventions, systemic thrombolysis and surgical embolectomy (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.74–2.53; p<0.01), similar bleeding complications (OR 1.10, 95% CI 0.88–1.37) and decreased utilisation of inferior vena cava (IVC) filters (OR 0.71, 95% CI 0.58–0.88; p<0.01) in the PERT group. Furthermore, there was a nonsignificant trend towards decreased mortality (OR 0.87, 95% CI 0.71–1.07; p=0.19) with PERTs.ConclusionsThe PERT group showed an increased use of advanced therapies and a decreased utilisation of IVC filters. This was not associated with increased bleeding. Despite comprising more severe PE patients, there was a trend towards lower mortality in the PERT group.

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Section: Resultsmentioning

confidence: 99%

Section: Descriptive Review and Study Characteristicsmentioning

confidence: 99%

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Impact of pulmonary embolism response teams on acute pulmonary embolism: a systematic review and meta-analysis

et al. 2022

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“…Overall, 31.5% of patients with acute PE were, irrespectively of their risk class, evaluated by a PERT across 8 studies [14,16,17,[24][25][26][27]36]. The median number of specialties involved in PERT across all included studies was 6.5 (range 2-10).…”

Section: Composition and Operation Of Pertsmentioning

confidence: 99%

Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis

et al. 2022

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Background Over the last years, multidisciplinary pulmonary embolism response teams (PERTs) have emerged to encounter the increasing variety and complexity in the management of acute pulmonary embolism (PE). We aimed to systematically investigate the composition and added clinical value of PERTs. Methods We searched PubMed, CENTRAL and Web of Science until January 2022 for articles designed to describe the structure and function of PERTs. We performed a random-effects meta-analysis of controlled studies (PERT vs. pre-PERT era) to investigate the impact of PERTs on clinical outcomes and advanced therapies use. Results We included 22 original studies and four surveys. Overall, 31.5% of patients with PE were evaluated by PERT referred mostly by emergency departments (59.4%). In 11 single-arm studies (1532 intermediate-risk and high-risk patients evaluated by PERT) mortality rate was 10%, bleeding rate 9% and length of stay 7.3 days [95% confidence interval (CI) 5.7–8.9]. In nine controlled studies there was no difference in mortality [risk ratio (RR) 0.89, 95% CI 0.67–1.19] by comparing pre-PERT with PERT era. When analysing patients with intermediate or high-risk class only, the effect estimate for mortality tended to be lower for patients treated in the PERT era compared to those treated in the pre-PERT era (RR 0.71, 95% CI 0.45–1.12). The use of advanced therapies was higher (RR 2.67, 95% CI 1.29–5.50) and the in-hospital stay shorter (mean difference − 1.6 days) in PERT era compared to pre-PERT era. Conclusions PERT implementation led to greater use of advanced therapies and shorter in-hospital stay. Our meta-analysis did not show a survival benefit in patients with PE since PERT implementation. Large prospective studies are needed to further explore the impact of PERTs on clinical outcomes. Registration Open Science Framework 10.17605/OSF.IO/SBFK9. Graphical abstract

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“…Patient care quality is largely associated with the individual level of variability in clinical decision-making and the multidisciplinary management of a disease (4). In this scenario, an ICP provides the opportunity to establish dedicated units, clinical pathways, rapid pathways and other actions such as the creation of pulmonary embolism response team (PERT) (5)(6)(7)(8)(9), unfortunately, at the moment, in our hospital we do not have a PERT.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the impact of an integrated care pathway for pulmonary embolism: a quasi-experimental pre-post study

et al. 2021

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Value-based assessment of implementing a Pulmonary Embolism Response Team (PERT)

Cited by 30 publications

References 15 publications

Impact of pulmonary embolism response teams on acute pulmonary embolism: a systematic review and meta-analysis

Impact of pulmonary embolism response teams on acute pulmonary embolism: a systematic review and meta-analysis

Pulmonary embolism response team (PERT) implementation and its clinical value across countries: a scoping review and meta-analysis

Evaluation of the impact of an integrated care pathway for pulmonary embolism: a quasi-experimental pre-post study

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