title: Outcomes before and after the Implementation of a Critical Pathway for Patients with Acute Aortic Disease.
abstract: OBJECTIVE
  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).
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyu Chul
authors.initials: KC
authors.lastname: Shin
authors.affiliation: Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Hye Sun
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
authors.forename: Joon Min
authors.initials: JM
authors.lastname: Park
authors.affiliation: Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.
authors.forename: Hyun-Chel
authors.initials: HC
authors.lastname: Joo
authors.affiliation: Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: Young-Guk
authors.initials: YG
authors.lastname: Ko
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Incheol
authors.initials: I
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea. boringzzz@yuhs.ac.
authors.forename: Min Joung
authors.initials: MJ
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001011:Aorta; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019091:Critical Pathways; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Critical pathway; aorta; aortic aneurysm; aortic dissection; clinical protocol; mortality