Process and outcome evaluation of a regional pulmonary embolism response team

BACKGROUND: Most pulmonary embolism response team (PERT) reports are limited to single hospitals. We evaluated whether process and clinical outcomes differed for patients presenting to pulmonary embolism (PE) referral versus non-referral centers within a regional PERT program. We also compared outcomes among the three PE referral centers. METHODS: We retrospectively analyzed registry data from adult patients treated by a PERT with centralized consultation and transfer protocols across 20 emergency departments (EDs) in North Carolina (2017–2024). Process and clinical outcomes were compared between centers using chi-square tests and t-tests. We identified temporal trends in the aggregate data. RESULTS: Of 2119 patients, 1173 and 946 had ED PERT activations at referral centers and non-referral centers, respectively. Of non-referral center activations, 534 (56.4%) were transferred to a referral center. Times were longer for patients who presented to referral centers vs. non-referral centers for some process outcomes (e.g., time to first heparin), but shorter for others (e.g., time to catheter-directed thrombolysis [CDT]). We found no significant differences between referral and non-referral centers in advanced intervention use (22.1% vs. 21.9%, p = 0.92), clinical deterioration (14.6% vs. 14.6%, p = 1.00), or major bleeding (9.1% vs. 7.0%, p = 0.08). However, PE severity and clinical deterioration (CD) varied significantly between referral centers (15.0% vs. 17.8% vs. 10.5%, p = 0.008), while advanced intervention use (22.0% vs. 21.2% vs. 23.2%, p = 0.76) and major bleeding (9.8% vs. 10.3% vs. 7.3%, p = 0.28) did not. CD and major bleeding changed significantly over time (p < 0.008); CDT and mechanical thrombectomy (MT) increased nonlinearly (p < 0.001); and systemic thrombolysis (ST) remained stable. Times to MT and ST decreased over time (p < 0.02). There was no change in timing for heparin or CDT (p > 0.3). CONCLUSIONS: In our regional PERT with centralized consultation and transfer protocols, process and clinical outcomes were similar between referral and non-referral centers. There were significant differences in PE severity and CD between referral centers, but advanced intervention use and major bleeding were similar. We identified temporal trends, reflecting expanded availability of interventional therapies and our PERT evolution.