Tuesday, July 13, 2021
Beaumont’s Pulmonary Embolism Response Team (PERT) now receives extraordinary number of patients from across the state
A specialized Beaumont Health team has cut mortality in half for patients with potentially life-threatening blood clots - especially important during the COVID pandemic.
Nearly 8% of patients with pulmonary embolism, or PE, died prior to the initial creation of Beaumont's Pulmonary Embolism Response Team, or PERT, in 2015. Now, the coordinated response of PERT’s specialized interventional cardiologists, radiologists, emergency medicine physicians and PERT medical staff dropped the mortality rate to 4% – and as low as 2.3% before a surge of critically ill patients – with a record number of patients expected this year.
Since the program began, more than 2,000 patients diagnosed with pulmonary embolism have been evaluated by the PERT team and survived the potentially fatal condition, said cardiologist Dr. Terry Bowers, founder and lead of the team at Beaumont Hospital, Royal Oak.
“Many of our most recent patients have COVID, with blood clots a distinct side-effect in some patients,” said Dr. Bowers, who is also a director of Vascular Medicine. “We are grateful to have this highly skilled team in place to treat patients who come to us from across Michigan. Rapid response is crucial for these patients’ survival, and we’ve become highly skilled in our reaction with a multidisciplinary team.”
Pulmonary embolism occurs when a blood clot in the body breaks free, moving through the right heart and into the lungs, where it becomes lodged in the pulmonary arteries. That increases resistance of the outflow of blood from the right side of the heart, which can rapidly and unpredictably lead to potentially deadly heart failure.
Aside from a known side-effect of COVID-19, risk factors for pulmonary embolism include obesity, immobilization due to surgery, cancer and smoking. Symptoms include shortness of breath; chest pain; a cough, sometimes with blood; back pain; dizziness or passing out.
The symptoms often mimic a heart attack. Prior to the PERT team implementation in 2015, diagnosing pulmonary embolism in patients in the emergency center was left to a single practitioner in charge of tending to the patient, with various avenues of treatment and no distinct protocol to follow.
Dr. Bowers saw an opportunity to improve care: create a protocol for patients coming through the emergency department doors or referred within the hospital suspected of having a pulmonary embolism. After a heart attack is ruled out, the diagnosis of pulmonary embolism is typically made by performing a CT scan in the emergency center. The protocol then calls for assembly of the PERT experts, who quickly consult and create a patient-specific treatment plan.
The result was stunning. Mortality for in-patient and walk-in emergent PE patients dropped by more than half, from 8% to 3.4%.
By the end of 2017, the hospital system grew the PERT program, implementing an official Rapid Response Team (RRT) risk stratification protocol and team conference discussions for all higher risk PE patients. Consequently, in-hospital mortality for patients managed by the PERT team improved an additional 32%, from an in-hospital mortality rate of 3.4% to 2.3%.
“Our program is one of few hospitals nationally that risk-stratifies every PE that comes in the door,” said Dr. Bowers. “And we have 2500 PE patients per year that come through the doors at Beaumont Health. That’s many lives saved.”
Other hospitals across the region soon heard about the PERT team's success. They began transferring their sickest potential PE patients by ambulance and helicopter to the specialized Beaumont program in the hopes of saving their lives. The number of incoming transferred PE patients jumped from 27 patents in 2017 to 100 transfers in 2019 and 81 in 2020. With the influx of the region's most critically ill patients came an increase in the mortality rate, just below 4% in 2020 - still significantly lower than when the program began.
Now with the increase of COVID-related clotting disorders and PE, the Beaumont PERT team is on track to treat more than 750 patients with intermediary or high-risk pulmonary embolism in 2021.
“At Beaumont, where our goal is to provide compassionate, extraordinary care, we are proud to affect survival so dramatically,” Dr. Bowers said. “It couldn’t happen without a tremendous number of dedicated Beaumont PERT providers working together to save and improve our patients’ lives.”