WTP1.1 Ruptured AAA pathway time audit within East Kent Hospitals University foundation trust (EKHUFT)

Abstract

Abstract Background With ruptured abdominal aortic aneurysms (rAAA) without rapid intervention, there is almost 100% mortality. Even with intervention mortality remains high and It is intuitive that more rapid access to specialist care might reduce this, though the choice of which patients are transferred lacks evidence. Kent and Canterbury hospital (K&CH) is the vascular hub for rAAAs in Kent, serving 4 spoke hospitals. Aim To assess the current speed of management of rAAA within Kent Hospitals. Methods An audit of 50 rAAA patients from 11/2019-10/2021 was conducted. 26 patients (52%) died without intervention, 10 of them after the transfer to the vascular facility. 11 patients (22%) underwent open surgical repair and 13 patients (26%) underwent EVAR. Of those who underwent intervention (24 patients), only 11 survived. From hospital attendance to CTA and from CTA clinching diagnosis to transfer to K&CH, the median times were 95(9-1140) and 70(27-370) minutes, respectively. Median time from arrival to K&CH to theatre was 90(11-190) minutes. Conclusions There are no current explicit UK guidelines on the emergency management of rAAA, with variation in practice and our audit shows room for improvement, including patient selection for referral, diagnostic tools and the conditions under which the transfer is made. Thus, we have created a pathway to improve the rapid diagnosis and transfer between the Kent hospitals. A re-audit will be conducted to assess the effectiveness of this.