Length of stay reduction for pulmonary embolism patients with PERT-driven risk stratification

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Critical Care Medicine


Learning Objectives: The landscape for pulmonary embolism (PE) treatment is rapidly changing. Pulmonary Embolism Response Teams (PERT) have been implemented with the goal of improving care through rapid risk stratification and multidisciplinary initiation of care, leading to a reduction in mortality and length of stay (LOS). The 2014 ESC guidelines propose a risk-based algorithm to guide this management. While overall length of stay has been shown to decrease with implementation of PERT, there is little data on the relationship between PERT-driven risk stratification and length of stay.

Methods: PERT was implemented at a tertiary care center and all patients with PE present on admission (POA) were evaluated with clinical risk stratification based on the 2014 ESC PE Guidelines. Risk strata included high, high-intermediate, low-intermediate, and low-risk based on the simplified pulmonary embolism severity index (sPESI) score and presence of RV dysfunction, troponin elevation, or both. LOS for all patients with PE present on admission from 2014–2017 was collected from the Vizient database and was compared with the internal post-PERT implementation database from August 2017 to mid-May 2018. Statistical analysis of LOS by risk stratification in the post-PERT cohort was performed. Patient-level data from Vizient was not available and thus retrospective risk-stratification of these patients was not analyzed.

Results: Overall mean length of stay for patients with pulmonary embolism POA decreased from 7.46 to 5.43 days. After risk stratification, mean LOS was significantly lower between high-intermediate and low-intermediate risk (8.21 vs. 5.01 days, p=0.008), and significantly lower between low-intermediate and low risk patients (5.01 vs. 3.45 days, p=0.005). Patients in shock accounted for <4% of the population and were excluded from analysis.

Conclusions: These data demonstrate risk stratification in patients with PE present on admission at a tertiary care institution is associated with a reduction in mean length of stay, driven by the low-intermediate and low-risk populations. Risk stratification is an essential step for institutions planning to pursue outpatient treatment of low risk PE.





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