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

 Kyu Chul Shin  ;  Hye Sun Lee  ;  Joon Min Park  ;  Hyun-Chel Joo  ;  Young-Guk Ko  ;  Incheol Park  ;  Min Joung Kim 
 YONSEI MEDICAL JOURNAL, Vol.57(3) : 626-634, 2016 
Journal Title
Issue Date
Acute Disease ; Adult ; Aged ; Aneurysm, Dissecting/diagnosis ; Aneurysm, Dissecting/mortality ; Aneurysm, Dissecting/surgery* ; Aorta ; Aortic Aneurysm/diagnosis ; Aortic Aneurysm/mortality ; Aortic Aneurysm/surgery* ; Aortic Diseases/diagnosis ; Aortic Diseases/mortality ; Aortic Diseases/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*
Critical pathway ; aorta ; aortic aneurysm ; aortic dissection ; clinical protocol ; mortality
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.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Emergency Medicine (응급의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Min Joung(김민정) ORCID logo https://orcid.org/0000-0003-1634-5209
Park, In Cheol(박인철) ORCID logo https://orcid.org/0000-0001-7033-766X
Shin, Kyu Chul(신규철)
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Joo, Hyun Chel(주현철) ORCID logo https://orcid.org/0000-0002-6842-2942
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