Keywords: pulmonary embolism response team, pulmonary embolism response leader, chest pain unit

Background

Pulmonary embolism is the  third common cause of death worldwide. Challenges are: early recognition and diagnosis;  referral structures; processes; the complexity of the disease in acute treatment; variation of therapy between centers; subspeciality, differing guidelines from country to country, and long term outcomes.

In the last few years, there has been a paradigm shift in the therapy; from the historical surgical approach, through to  conservative therapy, and more recently, the game-changing interventional therapy, to rapidly restore the haemodynamics. 

Guidelines recommend a pulmonary embolism response team to increase the level of awareness; improve management outcomes;  build team-orientated approaches with rapid consensus on the most appropriate therapy ; to increase efficiency, quality of care and outpatient follow-up. 

Methods and Results

Team-orientated approach is not easy to put into practice in many countries. In our center, we have a pulmonary embolism response leader, who co-ordinates the ongoing appropriate patient care.

PERl advantages: 

Suitable in a decentralized system; permanent pressure due to staff shortages: avoidance of team conflicts; shortest way from decision to therapy and PERT alert only if necessery.

Moreover, PERT can lead to a paradox of overtherapy, as in many cases an experienced doctor can alone take the appropriate decision, or undertherapy due to decision to therapy delay. 

PERleader should have experience, appropriate qualifications, decision-making ability, assertiveness and monitor the patient at the Chest Pain Unit until diagnosis confirmation,risk stratification, and the course of treatment has been determined. 

We developed a score to define the best leader.  It is important to take into consideration training program differences.  

Table 1: a score to define the best pulmonary embolism response leader.  

O/E= on examination, ICU: Intensive care unit, ECG: elektrocardiogram, TTE: transthorathic echocardiography, TOE: tranosephageal echocardiography. 

Yes (+) = 1 point, No (-) = 0 point, Maybe (+/-) = 0.5 point.

Conclusion: 

The team-orientated approach for the management of pulmonary embolism is not easy to realise in many countries. A Pulmonary Embolism Response Leader or Hybrid concept can be a good compromise.