Pulmonary Embolism Response Team

At Beaumont Health, we recognized an opportunity to advance care and treatment for pulmonary embolism (PE) patients. Our innovative approach pioneered a nationally recognized Pulmonary Embolism Response Team (PERT) at Corewell Health William Beaumont University Hospital.

PERT program highlights

The PERT program at Royal Oak was established in 2015 by a collaborative team of interventional cardiologists and radiologists. 

Our PERT program provides individualized treatment plans using a standardized risk-based approach and collaboration from a team of experienced PE specialists. This process allows the PERT team to respond within minutes to prevent and treat potentially life-threatening medical emergencies caused by PE blot clots.

The coordinated PERT program at Corewell Health William Beaumont University Hospital serves as a transfer resource for other hospitals receiving critically ill patients with pulmonary embolism blood clots.  

Patient evaluation at diagnosis

• When our patients are diagnosed with acute pulmonary embolism blood clots, our PERT team is immediately activated. 
  
• Within minutes, a specialized provider is available at our patient's bedside to start a standardized risk-based assessment of the patient’s clinical status, diagnostic images, blood work and vital signs. 
  
• Identifying each patient’s risk level helps to determine the most beneficial course of treatment for each patient.

Rapid response to higher risk or life-threatening PE

• If the PERT team determines the pulmonary embolism is higher risk, the group will hold an emergent teleconference to develop the best treatment plan.
• This call will include a team of pulmonary embolism specialized interventional cardiologists, interventional radiologists, emergency medicine physicians and our extracorporeal membrane oxygenation (ECMO) surgeons
• Our patients with a higher risk of pulmonary embolism are all cared for in the cardiac intensive care unit until the team feels they are stable to be transferred to a regular medical unit or discharged home.

Cardiovascular Shock Team is ready

• The PERT program also includes a Cardiovascular (CV) Shock Team to provide emergency treatment to patients who are experiencing cardiogenic shock due to a pulmonary embolism blood clot and other causes. Cardiogenic shock can happen when the heart muscle cannot pump enough blood because of a PE blood clot, which can be rapidly life threatening. 
• When activated, the CV Shock team collaborates immediately on a teleconference to determine the most beneficial course of treatment for each patient. Treatment options include medications, catheter-based procedures, surgery, or ECMO therapy to support the heart and lungs in a circuit outside the body.

Comprehensive care and follow up

• During the hospital stay, patients will be started on a blood thinner to prevent clots from becoming larger and to prevent new clots from forming. We will also work with our patients to identify why the blood clot developed in the first place.
• Physicians who perform emergent procedures related to the PERT or CV Shock programs follow our patients throughout their hospital stay.
• After discharge, we can schedule follow-up visits for our patients to meet with their pulmonary embolism specialists at our pulmonary embolism Transition Clinic in the Corewell Health William Beaumont University Hospital Max & Debra Ernst Heart Center. In these visits, the pulmonary embolism specialist manages treatment, blood thinner therapy and helps patients identify and reduce risk factors that may have influenced the initial blood clots. The patient is then safely transitioned back to their consultant cardiologist.

Treatment for low risk PE clots

• Our PERT team will also identify patients, through risk stratification, in the emergency room who present with low risk pulmonary embolism blood clots that may be safely transitioned home for outpatient treatment.
• As part of our follow-up process for these low risk patients, we can schedule a visit at our Pulmonary Embolism Transition Clinic in the Corewell Health William Beaumont University Hospital Max & Debra Ernst Heart Center within one week of discharge.

Statistics and outcomes 

Since its inception, the PERT program has provided care for nearly 2,000 patients with PE blood clots. Because of our high patient volumes and collaborative team-based approach, we’ve been able to learn and make significant improvements in how we evaluate and treat patients with PE blood clots. 

One recent example is transitioning our first-line treatment strategy to catheter-directed (CD) therapies, where interventionalists use small catheters to suction out clots (thrombectomy) or dissolve clots by dripping small of clot-busting medications (thrombolysis) over a period of time to reduce bleeding risk. Using these approaches at Beaumont has significantly reduces 30-day mortality, length of stay in the hospital, and major bleeding rates for those patients who are appropriate candidates for CD therapies.

Because Beaumont offers 24/7 coverage by a multidisciplinary group of PE experts, we have become a transfer resource for PE patients from other hospitals. In 2017, Corewell Health William Beaumont University Hospital received 27 transfers from other hospitals for patients with PE, increasing to 92 transfer PE patients in 2019. This trend reflects of our commitment to program excellence, and our capacity to care for more critically ill patients. 

Since launching the PERT program, Corewell Health William Beaumont University Hospital has also increased the number of patients discharged on a direct oral anticoagulant (DOAC) instead of older blood thinner medications like warfarin (Coumadin) or enoxaparin (Lovenox). DOACs are known to have significantly less interactions with food and medications, lower rate of bleeding events and are much easier to administer as they do not require routine blood work. Current practice far exceeds pre-PERT program data, where historical volumes for discharging patient on a novel oral anticoagulant was below 30%.