Positive Impact of an Aortic Center Designation
Adam Tanious, MD1, Mathew Wooster, MD1, Marcello Giarelli, MSN2, Paul Armstrong, DO1, Karl A. Illig, MD1, Bruce Zwiebel, MD3, Robert Hooker, MD4, Christiano Caldeira, MD4, Martin A. Back, MD5, Murray L. Shames, MD1.
1University of South Florida, Tampa, FL, USA, 2Tampa General Hospital, Tampa, FL, USA, 3Division of Radiology USF Health Morsani School of Medicine, Tampa, FL, USA, 4Division of Cardiothoracic Surgery USF Health Morsani School of Medicine, Tampa, FL, USA, 5Division of Vascular Surgery University of Florida, Gainesville, FL, USA.
Objective: 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, 2015 were entered into a prospectively collected database. Data was compared with available data for 2014. Primary outcomes were number of aortic related procedures (open abdominal, open ascending/arch, endovascular), 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 189 to 300 cases. This reflected an overall 59% (P = .0167) increase in all aorta-related procedures. The increase was most notable for open abdominal/thoracoabdominal procedures (26 to 65, 150%) and ascending aortic repairs (23 to 50, 117%), while the combined EVAR and TEVAR case volume increased from 113 to 146 (29%) in the 2 years. Secondary interventions for endoleaks increased from 27 to 39 (44%)
We had a 65% overall increase in transfer requests with 156% increase in acceptance of referrals and 136% drop in transfer denials (P < .0001). Emergent abdominal aortic cases accounted for 17% (n = 45) of our total aortic volume in 2015.
The average transfer time from request to arrival decreased from 515 minutes to 352 minutes, though this change was not statistically significant. We did see a significant increase in use of air-transfers for aortic patients (P = .0041). Factorial analysis showed that time for transfer was affected only by air-transfer use, regardless of the year the patient was transferred.
Conclusion: 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 EMS communication demonstrated a trend toward more efficient transfer times.
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