title: Implementation of a dedicated cardiovascular and stroke unit in a crowded emergency department of a tertiary public hospital in Brazil: effect on mortality rates.
abstract: BACKGROUND
  Emergency department (ED) care for acute vascular diseases faces the challenge of overcrowding. A vascular unit is a specialized, protocol-oriented unit in the ED with a team trained to manage acute vascular disorders, including stroke, coronary syndromes, pulmonary embolism (PE), and aortic diseases.
  
  
  OBJECTIVE
  The objective was to compare case fatality rates for selected cardiovascular conditions before and after the implementation of a vascular unit.
  
  
  METHODS
  Patients with the selected diagnoses admitted to the ED in two different time periods, 2002 through 2005 (before unit opening) and 2007 to 2010 (after vascular unit opening), were identified by ICD-10 codes, and their electronic records were reviewed. Case fatality rates were calculated and compared for both time periods.
  
  
  RESULTS
  The period prior to unit implementation (2002 through 2005) included 4,164 patients, and the vascular unit period (2007 to 2010) included 6,280 patients. Overall, the case fatality rate for acute vascular conditions decreased from 9% to 7.3% with vascular unit implementation (p = 0.002). The in-hospital mortality rates for acute coronary syndrome (ACS) dropped from 6% to 3.8% (p = 0.003), and for acute PE dropped from 32.1% to 10.8% (p < 0.001). The stroke case-fatality rate did not decrease despite improvements in the quality of stroke health care indicators.
  
  
  CONCLUSIONS
  The vascular unit strategy has the potential to reduce overall mortality for most acute vascular conditions.
authors.affiliation: Department of Internal Medicine, Federal University of Rio Grande do Sul, Rio Grande do Sul, Brazil.
authors.forename: Luiz A
authors.initials: LA
authors.lastname: Nasi
authors.forename: Andre L
authors.initials: AL
authors.lastname: Ferreira-Da-Silva
authors.forename: Sheila C O
authors.initials: SC
authors.lastname: Martins
authors.forename: Mariana V
authors.initials: MV
authors.lastname: Furtado
authors.forename: Andrea G
authors.initials: AG
authors.lastname: Almeida
authors.forename: Rosane
authors.initials: R
authors.lastname: Brondani
authors.forename: Letícia
authors.initials: L
authors.lastname: Wirth
authors.forename: Marisa
authors.initials: M
authors.lastname: Kluck
authors.forename: Carisi A
authors.initials: CA
authors.lastname: Polanczyk
mesh_terms: D001938:Brazil; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000628:therapy; D003441:Crowding; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006757:Hospital Units / Q000458:organization & administration*; D006779:Hospitals, Public / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000401:mortality / Q000628:therapy; D062606:Tertiary Care Centers / Q000458:organization & administration