Radiology as a Vanguard for Multidisciplinary Care Team Activation: Pulmonary Embolism Response Team Development

Purpose: Pulmonary embolism (PE) is a disease with potentially high morbidity and mortality, with significant variability based on time from diagnosis to treatment. As understanding of the acute and chronic sequelae of the disease and treatments improve, PE is increasingly evaluated and treated by a multidisciplinary approach, resulting in the growth of pulmonary embolism response teams (PERTs). As reported by Schultz et al (2019), most PERTs currently designed are enacted by the clinician responsible for the patient at the time of diagnosis. However, this may result in increased time to evaluation and limit system follow-up evaluation. We designed a PERT enacted at the time of imaging diagnosis and describe our initial experience.

Materials and Methods: PERT activation occurred at the time of radiographic diagnosis, with the diagnostic radiology (DR) team reading a positive PE on chest computed tomography or ventilation/perfusion scan. The DR contacts the ordering provider with the findings and notifies the PERT via a group-paging system. The PERT page includes the patient medical record number and right ventricle–to–left ventricle ratio. The PERT consists of the in-house intensive care unit (ICU) provider, interventional radiology (IR), and interventional cardiology. After review by the ICU team, if warranted (e.g., low-intermediate risk PE or above), a virtual conference call occurs within 15 minutes to discuss additional diagnostic workup, treatment, and follow-up for the patient. If further workup or interventions are recommended, the ICU team communicates to the primary team to ensure rapid, closed-loop communication of PERT recommendations. The patient is then followed by the appropriate team(s) to monitor for decompensation that could require escalation of care, as well as appropriate long-term follow-up.

Results: The PERT went live August 1 and was activated 38 and 31 times in August and September, respectively, at our 732-bed academic institution. A benefit of our PERT design is it allows data collection of every PE seen at our medical center, allowing evaluation of long-term follow-up.

Conclusions: We describe and share the formation and early experience of a radiology-based multidisciplinary team activation. As technological advances and multidisciplinary care teams increase, DR and IR are uniquely positioned to synergistically create and lead these teams to improve time to evaluation, treatment, and follow-up of various patient populations.