Yonsei Med J.  2016 May;57(3):626-634. 10.3349/ymj.2016.57.3.626.

Outcomes before and after the Implementation of a Critical Pathway for Patients with Acute Aortic Disease

• Shin KC
• Lee HS
• Park JM
• Joo HC
• Ko YG
• Park I
• Kim MJ

• KMID: 2374081
• DOI: http://doi.org/10.3349/ymj.2016.57.3.626

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.

Keyword

Critical pathway; clinical protocol; aorta; aortic dissection; aortic aneurysm; mortality

MeSH Terms

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

Figure

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  Fig. 1 Protocol of critical pathway. ED, emergency department; CT, computed tomography; ICU, intensive care unit.

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  Fig. 2 Performance of critical pathway. ED, emergency department; ICU, intensive care unit.

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