At a Glance
- The Acute Cardiovascular/Cerebrovascular Emergencies (ACE) network was established to facilitate rapid transfer and admission of emergent patients.
- Utilizing established protocols correctly will help ensure patients get the care they need at the right time and in the right place.
- A case study shows the significant impact ACE can have when patients need advanced treatment not available at their local hospital.
When rapid response is critical to a patient’s survival, the processes in place to get him to the right place at the right time are just as important as the treatment itself. That’s why UVA Health System has implemented the Acute Cardiovascular/Cerebrovascular Emergencies (ACE) network.
With long-established protocols in place to ensure rapid transfer and admission of patients experiencing a stroke or ST-elevation myocardial infarction (STEMI), UVA has broadened its alert process in recent years to include sudden cardiac arrest, aortic dissection and aneurysm and pulmonary embolism.
“When patients have some type of life- or limb-threatening emergency, whether it is stroke or an acute coronary emergency like aortic dissection or massive PE, we give them a point of entry from any number of pathways, such as EMS, a referring provider or another ED,” says David Burt, MD, director of the UVA Chest Pain Center. “Once an alert is initiated, a UVA decision-maker can help make the right diagnosis, determine if coming to UVA is the right thing to do and then remove all barriers to get the patient here.”
Each type of emergent condition has a designated pool of attending physicians on call 24/7 to provide a customized solution for each patient. Sometimes that includes sending a patient to another, closer hospital or consulting with another provider on a diagnosis or treatment from afar via phone or using telemedicine technology.
“For this network to be patient-centric, we want to do what makes sense for the patient,” says cardiac surgeon John Kern, MD. “Sometimes that means sending patients to our colleagues in Roanoke or elsewhere because the patient may not survive the long transport if sent to UVA. The goal of this network is to get people the quickest care possible.”
3 Ways to Make the Most of ACE
To ensure your emergent patients get the right care at the right place at the right time, take a look at the top three tips below for utilizing the ACE network protocols effectively.
- Call the UVA Transfer Center at 844.XFERUVA (844.933.7882) and be clear that your patient has a cardiovascular or cerebrovascular emergency. For example, “if you have a patient with an aortic dissection, then tell the operator you have an aortic catastrophe,” says Kern. “If a provider calls me directly or does not notify the operator that it is an aortic emergency, then the process doesn’t happen as quickly.”
- Send images immediately. If images are uploaded to the UVA network, a UVA attending physician can look at a CT or other scan while speaking with the ED provider, confirm a diagnosis and begin planning treatment even before the patient is transferred.
- Utilize telemedicine. Videoconferencing technology is being widely used to provide remote consultations to stroke patients at UVA partner sites. The goal is to adopt the same protocols for acute cardiovascular emergencies as well. “The goal is to gradually incorporate telemedicine into all ACE network encounters so that patients can get in front of a screen and consult with a UVA provider before they arrive to us,” says Burt.
Case Study: Aortic Alert Done Right
Patient: Catherine Foret, age 80
Presented with: Pain and heaviness in the chest and jaw, visual disturbance
Catherine Foret arrived at Culpeper Hospital at 4:30 a.m. on Friday, April 26. Earlier that week, she had visited a hospital in Northern Virginia with symptoms of back pain, heaviness in the upper part of the chest and jaw pain. After an electrocardiogram showed normal heart function, she was released. However, symptoms persisted and she sought additional care.
“The fact that she had been at another hospital and apparently had two normal heart markers even though she said she had ongoing pain drew me away from this being a heart attack,” says Culpeper ED physician Megan Starling, MD. “The description of her pain, which was going up her neck, and the fact that she had visual disturbance made me concerned there was something more going on. So I called radiology and had them do a CAT scan STAT.”
Diagnosis: Dissection in proximal aorta
As soon as the call came in from radiology with the diagnosis, Starling initiated the aortic alert process. “As I was talking to the radiologist on the phone, I turned to my assistant and told her we have a code aorta,” says Starling. “As soon as she heard that, she knew what to do; we’ve done drills to practice these alerts.”
Starling’s assistant called the UVA Transfer Center and told the operator that they had an aortic alert. She then called radiology and had the team immediately transfer images to UVA.
Starling communicated the diagnosis to the patient and her husband and informed them of the need to transfer Catherine to UVA. “Within five minutes of initiating the aortic alert, I heard from the vascular surgeon at UVA,” says Sterling. “As I was speaking with him, we had an ambulance transfer crew there and they began loading Mrs. Foret and getting her ready to move.”
Transfer Time: 45 minutes
Catherine Foret was transferred by ambulance to UVA in approximately 45 minutes. “In the time that it took for the patient to transfer to UVA, we were able to get everything ready for her in the OR,” says UVA vascular surgeon John Kern, MD. “The ICU was able to plan their day around her arrival and have the right resources in place.”
Treatment: Type A dissection repair
Catherine was taken directly to the operating room where she underwent surgical repair of her Type A dissection. Because the entire team was well prepared in advance, her complex operation went very smoothly and she was transferred to the ICU later that day in stable condition.
Outcome: Complete repair and recovery
By 9 p.m. on the day of the surgery, Catherine was extubated. By the next morning, she was sitting up in bed eating breakfast and she took a walk in the hallway. “The therapist bragged about the strength in her legs and core,” says Catherine’s husband, Gene. “Most of her life she wore out her treadmill; she walked religiously five days a week. After a week and a half at home, she was walking the length of the house and she continues to improve. Her progress has been outstanding.”
When asked about Catherine’s transfer to UVA, Gene adds: “The thing that blows my mind is the speed at which UVA knew what they were up against. For that 45-minute ambulance ride, they were preparing for her based on what they knew from the doctor at Culpeper and what they received electronically. Without that process in place, we could’ve lost my precious angel.”