CV
Eric Whitley, RT (R) (VI) (CI)
Vascular Team Leader
Code Rupture Project Manager
Carolina Medical Center
Patricia M. Pye, RN, BSN, MS
Assistant Vice President
Cardiovascular Services
Sanger Heart and Vascular Institute
Carolinas Healthcare System
CODE
ruptured abdominal aortic aneurysm
Establishing a protocol
to expedite treatment
for ruptured abdominal
aortic aneurysm
Claiming more than 15,000 lives each year, Ruptured Abdominal Aortic Aneurysm (rAAA) is the thirteenth leading
cause of death in the U.S. with a 75-90 percent mortality
rate that has remained stagnate over the past several decades. Of the population who experience a rAAA, only 50%
will reach a treatment facility alive, and only half of those
who do will live to 30 days post operatively.
Until recently, little has been accomplished to reduce this
staggering rate. The mortality rate of rAAA patients may
significantly decrease through the use of several recent
technological advancements, including: utilization of a
multidisciplinary unified strategy, regionalization of a
standardized protocol to expedite treatment to high volume
experienced treatment centers, and adoption of Endovascular Aortic Repair (EVAR) techniques.
The Carolinas Medical Center (CMC) located in Charlotte,
North Carolina, the region’s only level 1 Trauma Center, has
taken on the challenge of reducing rAAA mortality from a
regional perspective.
PROCESS IMPROVEMENT
The process improvement, known as Code Rupture, was
initiated in May of 2011 by the Cardiovascular Invasive
Lab’s (CVL) team recognizing several opportunities to
improve upon the approach and treatment of the patient
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presenting with a rAAA.
The improvement process began by performing evidence-based research as a guide to how and why to change
the current process. Through research we confirmed that
being a high volume elective AAA and rAAA treatment center and regional healthcare provider, the Carolinas Medical
Center is positioned to offer a higher probability of better
surgical outcomes due to surgeon and team experience.
It was determined that a multidisciplinary team approach
to the challenge was necessary, as well as the creation of
an efficient and seamless, standardized protocol to provide
for a rapid system of communication, patient registration,
blood product procurement, and the maintenance of a Code
Rupture-ready operating room at all times.
After performing the evidence-based research to support
building a Code Rupture program, the key stakeholders and
physicians were identified by the CVL team. Armed with
supporting studies and documentation to show how we, as
a healthcare system, could improve rAAA mortality rates, a
drive began to gain support for the Code Rupture concept
through e-mails, phone calls, and by literally knocking on
doors.
Soon afterward, a Code Rupture Committee was assembled
which included all stakeholders: MedCenter Air, TeleHealth
Solutions, Emergency Department, Clinical Program
Development, Patient Registration, Radiology, Blood Bank,
Surgical Services, Cardiac Cath Lab, and Anesthesiology.
The committee is a mix of staff that includes front-line
personnel and departmental AVP’s, as well as the key physicians. Gaining interdepartmental support and developing
an environment of teamwork has been critical to building
the Code Rupture program. Having physicians champion
the program from the Emergency Department, Anesthesia,
and Vascular Surgery perspectives is paramount.
CV DIRECTIONS VOL. 2, NO. 2