Strategies for Building a Successful VTE and PERT Program: A Case Study with Palmetto General Hospital

At ISET 2022, Venkat Tummala, MD, from Inari Medical, hosted a discussion with Ilan Rzadkowolsky-Raoli, MD, Adam E. Leisy, MD, FACEP, FAEMS, and Nadine Hassan from Palmetto General Hospital in Hialeah, Florida, where they discussed the development of VTE and pulmonary embolism response team (PERT) programs and presented VTE and PE case studies.

Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality behind acute myocardial infarction and stroke, and 80% of patients are diagnosed too late or not at all. Approximately two-thirds of PE patients die outside of the hospital. Dr. Tummala stressed the need for a systematic shift in how PE is treated, which should include deep vein thrombosis (DVT) as well, since concomitant DVT is seen in 70% of patients with PE. This shift includes development of DVT and PERT programs to better serve these patients, in which time is of the essence to create positive outcomes. Although algorithms exist for STEMI and stroke, there has been no real pathway for treating patients with PE. “It’s clear that a new system of care was needed,” said Dr. Rzadkowolsky-Raoli.

Drs. Rzadkowolsky-Raoli and Leisy outlined their strategies for creating a successful VTE and PERT program. Some of the elements to look for in a program include having a multidisciplinary team that can rapidly assess and provide treatment for patients with acute PE; finding your “champions” with your facility; working out all possible issues that can arise, such as when a code is activated, what happens when a code is called, who can call the code, and when interventionalists should be involved, among others; what interventions will be offered; and how outcomes will be tracked. “You have to know if you’re making a difference,” said Dr. Rzadkowolsky-Raoli.

Hospital administrator Hassan spoke about the value of establishing a PERT program; the program at Palmetto General Hospital decreased ICU length of stay by 44%. She emphasized the need to push for not only administrative involvement, but nursing as well, as nurses are often the ones who see possible PE in their patients first. Most important, she said, is that a facility’s PERT program is “a consistent pathway that will always be followed.”