Outcomes before and after the Implementation of a Critical Pathway for Patients with Acute Aortic Disease.
10.3349/ymj.2016.57.3.626
- Author:
Kyu Chul SHIN
1
;
Hye Sun LEE
;
Joon Min PARK
;
Hyun Chel JOO
;
Young Guk KO
;
Incheol PARK
;
Min Joung KIM
Author Information
1. Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea. boringzzz@yuhs.ac
- Publication Type:Observational Study ; Original Article
- Keywords:
Critical pathway;
clinical protocol;
aorta;
aortic dissection;
aortic aneurysm;
mortality
- MeSH:
Acute Disease;
Adult;
Aged;
Aneurysm, Dissecting/diagnosis/mortality/*surgery;
Aorta;
Aortic Aneurysm/diagnosis/mortality/*surgery;
Aortic Diseases/diagnosis/mortality/*surgery;
*Critical Pathways;
Emergency Service, Hospital/*organization & administration;
Female;
Hospital Mortality;
Humans;
Male;
Middle Aged;
Outcome and Process Assessment (Health Care);
Postoperative Complications/mortality;
Republic of Korea/epidemiology;
Retrospective Studies;
Time Factors;
Treatment Outcome;
Vascular Surgical Procedures/*methods
- From:Yonsei Medical Journal
2016;57(3):626-634
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Acute aortic diseases, such as aortic dissection and aortic aneurysm, can be life-threatening vascular conditions. In this study, we compared outcomes before and after the implementation of a critical pathway (CP) for patients with acute aortic disease at the emergency department (ED). MATERIALS AND METHODS: This was a retrospective observational cohort study. The CP was composed of two phases: PRE-AORTA for early diagnosis and AORTA for prompt treatment. We compared patients who were diagnosed with acute aortic disease between pre-period (January 2010 to December 2011) and post-period (July 2012 to June 2014). RESULTS: Ninety-four and 104 patients were diagnosed with acute aortic disease in the pre- and post-periods, respectively. After the implementation of the CP, 38.7% of acute aortic disease cases were diagnosed via PRE-AORTA. The door-to-CT time was reduced more in PRE-AORTA-activated patients [71.0 (61.0, 115.0) min vs. 113.0 (56.0, 170.5) min; p=0.026]. During the post-period, more patients received emergency intervention than during the pre-period (22.3% vs. 36.5%; p=0.029). Time until emergency intervention was reduced in patients, who visited the ED directly, from 378.0 (302.0, 489.0) min in the pre-period to 200.0 (170.0, 299.0) min in the post-period (p=0.001). The number of patients who died in the ED declined from 11 to 4 from the pre-period to the post-period. Hospital mortality decreased from 26.6% to 14.4% in the post-period (p=0.033). CONCLUSION: After the implementation of a CP for patients with acute aortic disease, more patients received emergency intervention within a shorter time, resulting in improved hospital mortality.
