Positive Impact of an Aortic Center Designation
| Autor: | Adam Tanious, Paul A. Armstrong, Brad L. Johnson, Karl A. Illig, Christiano Caldeira, Bruce Zwiebel, Murray L. Shames, Lawrence S. Grundy, Marcelo Giarelli, Martin A. Back, Mathew Wooster, Robert Hooker |
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| Rok vydání: | 2018 |
| Předmět: |
Time Factors
Databases Factual 030204 cardiovascular system & hematology 030230 surgery Workflow 0302 clinical medicine Trauma Centers Emergency medical services Cooperative Behavior Referral and Consultation Patient transfer Aorta medicine.diagnostic_test Delivery of Health Care Integrated Interventional radiology General Medicine Cardiac surgery Elective Surgical Procedures Florida cardiovascular system Centralized Hospital Services Cardiology Service Hospital Cardiology and Cardiovascular Medicine Elective Surgical Procedure Vascular Surgical Procedures Patient Transfer medicine.medical_specialty Aortic Diseases Workload Radiology Interventional Time-to-Treatment 03 medical and health sciences Terminology as Topic medicine.artery Radiologists medicine Humans Cardiac Surgical Procedures Retrospective Studies Patient Care Team Surgeons Radiology Department Hospital business.industry Retrospective cohort study Vascular surgery Surgery Emergency medicine Interdisciplinary Communication Emergencies business Program Evaluation |
| Zdroj: | Annals of Vascular Surgery. 46:142-146 |
| ISSN: | 0890-5096 |
| DOI: | 10.1016/j.avsg.2017.08.009 |
| Popis: | Background In January 2015, we created a multidisciplinary Aortic Center with the collaboration of Vascular Surgery, Cardiac Surgery, Interventional Radiology, Anesthesia and Hospital Administration. We report the initial success of creating a Comprehensive Aortic Center. Methods All aortic procedures performed from January 1, 2015 until December 31, 2016 were entered into a prospectively collected database and compared with available data for 2014. Primary outcomes included the number of all aortic related procedures, transfer acceptance rate, transfer time, and proportion of elective/emergent referrals. Results The Aortic Center included 5 vascular surgeons, 2 cardiac surgeons, and 2 interventional radiologists. Workflow processes were implemented to streamline patient transfers as well as physician and operating room notification. Total aortic volume increased significantly from 162 to 261 patients. This reflected an overall 59% ( P = 0.0167) increase in all aorta-related procedures. We had a 65% overall increase in transfer requests with 156% increase in acceptance of referrals and 136% drop in transfer denials ( P n = 45) of our total aortic volume in 2015. The average transfer time from request to arrival decreased from 515 to 352 min, although this change was not statistically significant. We did see a significant increase in the use of air-transfers for aortic patients ( P = 0.0041). Factorial analysis showed that time for transfer was affected only by air-transfer use, regardless of the year the patient was transferred. Transfer volume and volume of aortic related procedures remained stable in 2016. Conclusions Designation as a comprehensive Aortic Center with implementation of strategic workflow systems and a culture of “no refusal of transfers” resulted in a significant increase in aortic volume for both emergent and elective aortic cases. Case volumes increased for all specialties involved in the center. Improvements in transfer center and emergency medical services communication demonstrated a trend toward more efficient transfer times. These increases and improvements were sustainable for 2 years after this designation. |
| Databáze: | OpenAIRE |
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