CHEST Guidelines-Interhospital-Transfer-of-Patients-With-Acute-Pulm

Interhospital-Transfer-of-Patients-With-Acute-Pulm

Pdf Summary

The reviewed document focuses on the challenges and opportunities surrounding the interhospital transfer (IHT) of patients suffering from acute pulmonary embolism (PE), a condition with significant morbidity and mortality. The increasing availability of advanced treatments, such as catheter-directed therapies and mechanical support, has led to the formation of pulmonary embolism response teams (PERT) across various institutions. However, not all facilities can provide comprehensive PE care, necessitating patient transfers to specialized centers.<br /><br />Recent guidelines highlight the importance of PERTs in managing high-risk cases, but disparities persist, particularly in rural areas where thrombolytic use is less common and mortality rates are higher. A standardized and organized approach to IHT is lacking, essential for the survival of critically ill patients who need quick, precise, and informed medical interventions. The document outlines the process of stabilizing and transferring these patients, emphasizing the importance of timely anticoagulation, risk stratification, and advanced planning for transport.<br /><br />A thorough assessment must consider anticoagulation needs, risk stratification through the sPESI score, and medical optimization of airway, breathing, and circulation (ABC). Decisions on transfer depend on the patient's condition, the necessity for advanced management, and the capabilities of the referring institution. Medical teams are advised to ensure thorough communication between transferring and accepting centers, and employ safe transport strategies, particularly for high-risk PE patients.<br /><br />Key goals include reducing adverse events during transfer and ensuring patients receive timely, expert care at specialized centers, similar to protocols established for other acute conditions like myocardial infarction and stroke. The ultimate aim is to improve clinical outcomes by refining processes for IHT and fostering further research on patient outcomes post-transfer.

Keywords

interhospital transfer

acute pulmonary embolism

pulmonary embolism response teams

catheter-directed therapies

mechanical support

risk stratification

anticoagulation

thrombolytic use

rural healthcare disparities

patient stabilization