Effects of Implementing a Standardized Risk Stratification and Triage Workflow for an Established Pulmonary Embolism...

Area of Science:

• Cardiology
• Pulmonary Medicine
• Healthcare Quality Improvement

Background:

• The Pulmonary Embolism Response Team (PERT) model aims to improve decision-making and treatment for pulmonary embolism (PE).
• Previous studies suggest survival benefits from PERT, but specific workflow components driving this benefit remain unclear.

Purpose of the Study:

• To evaluate the impact of specific workflow interventions on patient outcomes within an established PERT program.
• To identify if designated triage, guideline-based risk stratification, and ICU admission guidelines improve survival in PE patients.

Main Methods:

• A quality improvement initiative implemented three workflow revisions: designated triage, guideline-based risk stratification, and ICU admission guidelines.
• Clinical outcomes, including in-hospital mortality, were compared for 253 patients managed with the revised workflow versus 167 patients under the historical workflow (2019-2023).
• Logistic regression analysis adjusted for relevant clinical variables was used to assess the impact on mortality.

Main Results:

• The revised PERT workflow was associated with a significant reduction in 30-day in-hospital mortality (6.3% vs. 18.0%, P < 0.001).
• Logistic regression confirmed a protective effect of the revised workflow against in-hospital mortality (OR = 0.31, P < 0.001), even after adjusting for multiple factors.
• The revisions increased the use of advanced therapies without affecting bleeding rates or length of hospital/ICU stay.

Conclusions:

• Implementing specific workflow revisions, particularly those focusing on risk stratification and triage, significantly improved survival for PE patients within an existing PERT program.
• These findings highlight the value of standardized approaches and risk stratification as key components of effective PERT interventions.