Jacobs Journal of Emergency Medicine

Implementation and Challenges of Establishing a Multi-Disciplinary Heart and Vascular Emergency System

Published on: 2017-07-27

Abstract

Background We developed a regionalized protocol at The Ohio State University Wexner Medical Center (OSUWMC) in order to improve outcomes of acute cardiac and vascular conditions by streamlining diagnosis, transport, and treatment through a team of coordinated multidisciplinary providers. In this manuscript, we discuss the challenges to implementation of our system, early outcomes of our protocol driven triage system and insights into barriers of adopting this in other institutions. Method and Results A multi-disciplinary team developed an algorithm to guide initial management, arrival, diagnosis and operative repair in patients with acute limb ischemia, ruptured aortic aneurysm, and acute aortic dissection. We recorded prospective data on number of referrals, time to treatment, in-hospital mortality, and length of stay from April, 2012 to October, 2014. 92 patients were referred for acute thoracic aortic dissections (AAD), 50 of which were operative. In-hospital mortality for AAD ranged from 12-18% since the program’s implementation. 38 patients were referred for ruptured aortic aneurysm (rAA); 25 received intervention and in-hospital mortality was 34%. 54 patients were referred for acute limb ischemia (ALI), and the limb salvage rate was 96% and in-hospital mortality was 9% since the program’s implementation. Conclusion Challenges to implementation included activation of the protocol, discouraging use of protocol for non-cardiovascular emergencies, optimizing diagnostic criteria and expedient treatment, and understanding how implementation affect the all of the providers involved. In future studies, we will compare/contrast our findings from before and after implementation of the regionalized protocol.

Keywords

Aortic Dissection, Acute Limb Ischemia, Cardiovascular Emergencies