Written by Catherine Burger
Spoon Feed
After starting a pulmonary embolism response team (PERT) at a large children’s hospital, all eligible cases of PE were activated, time to diagnosis and intervention decreased, and more patients received reperfusion, but length of stay and mortality was unchanged.
PE teamwork makes the diagnostic and treatment dream work
This hospital’s PERT plan worked by:
- gaining leadership buy-in
- collaboration with hematology, cardiology, critical care, emergency medicine, interventional radiology, pharmacy
- creation of a paging group
- creation of an electronic medical record order set
- building standard operating procedures for PE work up and care
- pre-planned outcome assessment.
They compared 2 years of post-PERT implementation data to two years prior at the same hospital. There were 30 pre-PERT patients and 31 post-PERT patients, with similar demographics between the two groups. Risk stratification was based on hemodynamic stability, right ventricular function on CTPA or echocardiogram, and troponin and BNP levels. Most were low-risk (57% pre-PERT and 71% post-PERT). PERT activation was for intermediate and high-risk cases, of which there were 13 over the two-year study period, and these were eligible for reperfusion therapy (surgical thrombectomy, catheter directed therapy, systemic tPA).
PERT activation with real-time virtual meetings leading to diagnostic and treatment plans occurred for all activations. Time to echocardiogram, anticoagulation order, and drug delivery were all decreased post-PERT (2.7 hours, 36 minutes, and 41 minutes quicker, respectively). The percent of eligible patients for reperfusion therapy who received it increased from 37% pre-PERT to 83% post-PERT (n = 8 pre-PERT and 6 post-PERT), specifically one thrombectomy and one tPA post-PERT. There were no differences in major bleeding, mortality, or length of stay (hospital or ICU).
How will this change my practice?
Even though PE is rare in pediatrics, the authors found improved metrics with this hospital-wide, quality-improvement-focused PERT. Although exact replication may not be possible outside of large tertiary care pediatric hospitals, it encourages me to support my local QI projects focused on patient-centered outcomes.
Source
Bringing PERT to Pediatrics: Initial Experience and Outcomes of a Pediatric Multidisciplinary Pulmonary Embolism Response Team (PERT). Chest. 2025 Mar;167(3):851-862. doi: 10.1016/j.chest.2024.09.028. Epub 2024 Oct 3. PMID: 39368735
