Standardization of Care Protocols at an APP-Led High Volume, Urban, Aortic Clinic for the Diagnosis and Management of Aortic Disease

A. Graham-Pardus¹, C. Erceg², E. Renee. Castor³, D. Serna-Gallegos⁴, I. Sultan^4
1UPMC, Murrysville, Pennsylvania ²UPMC, Pittsburgh, Pennsylvania ³UPMC, Beaver, Pennsylvania ⁴University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

Purpose: APPs often collaborate with multiple surgeons, necessitating standardized protocols and EMR documentation for outpatient visits, which ensures that clinical decisions are made with accurate and complete data and that patients receive consistent education for follow up and surveillance.

Methods: Utilizing an EMR template (Epic SmartPhrase), all APPs document:

1. Current aortic diameter, aortic size index, how long patient has followed with our Aortic Clinic, date and aortic size at diagnosis with serial progression of aortic growth
2. Documentation of any connective tissue disorder, type and status of genetic testing
3. Recommended surgical threshold and any surgical discussion at visit
4. Follow up imaging plan including timeframe and imaging modality
5. Detailed family history of aortopathy/catastrophe or sudden death and family screening recommendations

APPs also provide and document the following patient education: Signs and symptoms of an aortic dissection, blood pressure control guidance, activity restrictions, screening recommendations for first degree relatives, avoiding fluoroquinolone antibiotics (including a list) and smoking cessation.

Results: Compliance with documentation of standards of care are being evaluated by auditing clinic notes for a 3-month period pre- and post-project implementation. While we are still in the process of collecting weekly clinic data, there is nearly universal utilization of the EMR template and improved documentation. All patients are now reliably receiving standardized education, provided aortic emergency cards, and reminder sheets to take home for reference. Data will continue to be collected and analyzed prior to the STS annual meeting.

Conclusion: Using an EMR template for standardization of patient care and consistent documentation is a vital tool, ensuring clinical decisions are made with accurate and complete data, and that patients are provided with comprehensive education. Data can easily be updated at subsequent appointments by any APP in high-volume aortic centers with multiple APPs. The implementation of standardized care protocols at our high-volume aortic center serves as a model for a structured approach to aortic aneurysm patients at academic institutions in alignment with the 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease.

Identify the source of the funding for this research project: None