Grant Application

Nathan Liang, MD, UPMC Presbyterian

Proposed Innovation

A ruptured abdominal aortic aneurysm (RAAA) is a medical emergency. Despite significant medical advances, RAAA continues to be one of the most devastating vascular surgery emergencies with an in-hospital mortality rate of nearly 40%. Decision making in these cases is complex and minimizing delays in getting patients to the operating room is essential.

The goal of this project is to implement a system-wide multidisciplinary protocol for RAAA cases. The protocol would encompass every phase of care — from community-based hospital emergency departments, to UPMC’s MedCall referral center and the STAT MedEvac air ambulance, to UPMC Presbyterian’s emergency department and on-call staff for vascular surgery, including anesthesia and the operating room.

Improvements in Action

This protocol will be based on existing literature and discussion with stakeholder doctors and staff involved in each phase of care for RAAA patients. A paging notification system similar to that used for trauma or stroke activation will be used to enhance communication among the participating teams at UPMC Presbyterian. The protocol will serve as a “default template,” providing each team with clear instructions on patient management. In addition, outreach to community-based emergency departments will create awareness of the rupture activation protocol.

Intended Outcomes

Having an established protocol will improve the care given to patients. It will streamline care and decrease the burden of decision making for surgeons as well as the many health care providers involved in an RAAA patient’s care. In those cases when death is imminent, the protocol encourages palliative care conversations with family members to avoid unnecessary transfers or surgeries.