Carl J Aschkenasi, MD shares his perspective on the evolution of rapid response teams (RRTs) and the role of AI in pulmonary embolism (PE) care coordination.
The concept of the rapid response team (RRT) developed in the 1990s as hospitals recognized that some unexpected inpatient hospital deaths could perhaps be averted. Having a team of doctors with defined roles, rehearsed algorithms, and equipped to deploy very quickly has probably saved thousands of patients over the decades since these “code teams” began to be implemented. This effort began handling inpatient cardiac arrest and acute cardiac arrythmias, and has since been adopted by numerous specialties to deal with specific emergencies germane to their expertise.
As RRTs were becoming commonplace, an ostensibly unrelated trend was developing in tandem—the concept of multidisciplinary medicine. Multidisciplinary care is a potent (if somewhat obvious) notion, particularly in dealing with complicated conditions, or a multiplicity of conditions. At some point doctors recognized that for certain patient populations, collaboration across specialties could save resources, simplify logistics, improve patient satisfaction, and occasionally improve outcomes too.
But what if an emergent condition is best handled through collaborative medicine? What if there are diagnoses, or therapies, or both, that are best hashed out in a conference room (or a cafeteria table)? As anyone who has been involved in a tumor board conference can tell you, each such event is a preceded by a flurry of emails and phone calls to establish the who, what, when, and where. It would be nearly impossible to assemble the appropriate minds and bodies at a moment’s notice to address such an emergency.
But that’s so 90s of me. This is of course possible now—as a year of Covid isolation has shown the world, today we are comfortable (more or less) with technologies that allow us to engage in web conferencing with ease, right from the comfort of our smartphones. Add to this technology the ability of AI to use real-time clinical data to select appropriate patients, parse and assemble the relevant clinical data, and present it cogently, and you have arrived at a new synergy: the possibility of deploying a rapid response team staffed by every department chair in the hospital.
Pulmonary embolism (PE) is exactly the sort of paradigm to showcase this happy confluence of technology. PE is the third-most common cause of acute cardiovascular fatality in the Western world. It happens to both inpatients and outpatients. It can result in rapid cardiovascular collapse. Its diagnosis may begin in the ER, on the hospital ward, or in the ambulance. PE management crosses the domains of radiologists, pulmonologists, interventional radiologists, chest surgeons, and intensivists. Add to that, over 30 years of research and technologic development that have increased our options for therapy, while also increasing the controversies in weighing these options. The properly stratified patient suffering severe PE would benefit greatly from an informed, coordinated response from all relevant stakeholders in his care, coming up with a plan, from facility selection, to prepping for arrival, to administering the first therapy.
Aidoc’s new PE Care Coordination solution represents a recognition of the feasibility of such a scenario. When Aidoc’s triage and notification algorithm identifies a high-risk PE, an alert is sent out to the smartphone of every stakeholder in the PE treatment workflow. With integrated secure messaging and conferencing, a brief meeting can ensue to discuss the situation and agree on a plan. This communication is bolstered with relevant medical data, including key slices flagged by the AI algorithm, and extraction of additional data such as signs of right heart strain. With care coordination starting as soon as the AI alerts the PE intervention team, diagnosis and treatment time are shortened.
Carl J Aschkenasi, MD is a US-trained ABR certified radiologist based in Israel. He has worked in teleradiology since 2010, most recently with Virtual Radiologic, the largest teleradiology firm in the US. Born and raised in Newton, MA, USA, Dr. Aschkenasi graduated Harvard Medical School in 2002, and completed radiology residency in 2008 at Mallinckrodt Institute of Radiology at Washington University in St Louis, MO. He has served as an Aidoc consultant since 2017. He resides in rural Israel with his wife, three kids, two dogs, two hairless cats, and some fish.