Standardizing leave of absence and round-trip protocols for surgical management of pulmonary embolism

Pulmonary embolism (PE) remains a significant public health challenge, causing 100,000 to 200,000 deaths annually in the United States. Despite advances in medical technology, mortality rates for high-risk patients with PE remain substantial, highlighting the critical need for standardized interhospital transfer protocols for surgical management. In addition, as hospitals struggle with capacity challenges, other access mechanisms to advanced care for time-sensitive conditions should be explored.

This framework aims to develop detailed, evidence-based recommendations for leave of absence and round trip protocols specific to surgical PE management, addressing current gaps in patient transfer and intervention processes.

Through a detailed analysis of the large academic medical center's workflow, this paper examines current interhospital transfer practices for patients with PE. The methodology involves evaluating patient selection criteria, pretransfer medical optimization, transport logistics, and postprocedure care coordination, using validated risk assessment tools such as the simplified Pulmonary Embolism Severity Index score, Bleeding, Age, Cancer, Syncope, echocardiographic evaluations, and the 2026 American Heart Association/American College of Cardiology acute PE clinical categories (A-E). This work represents a quality improvement and protocol development analysis; as no primary patient data were collected, Institutional Review Board review was not required. This framework paper does not involve primary patient data collection; sex-disaggregated analysis is therefore not applicable.

The framework offers a systematic approach to improving surgical management of PE through standardized leave of absence and round trip protocols, potentially reducing mortality and improving patient care. The proposed framework includes rigorous patient selection criteria, specialized transfer team composition, thorough pretransfer optimization protocols, and standardized communication and documentation processes. Critical components include careful patient risk stratification, specialized critical care transport teams, and structured postprocedure monitoring and transfer protocols. By establishing a standardized approach to PE patient transfers, this paper aims to provide a construct for timely access to higher-level care to improve clinical outcomes, enhance patient safety, and optimize resource utilization across health care institutions.