This acute aortic dissection self-assessment questionnaire is designed to help identify any gaps in current service provision and/or opportunities to enhance or develop services or systems at a local level. Using these questions alongside local intelligence may also help to consider future demand.
The summary toolkit showing key actions is available here
There should be formal written governance arrangements between providers for day to day management and contingency plans.
| Competency | Competency Met | Comments |
|---|---|---|
| Do you have an appointed Clinical Lead? | no | fgfg |
| Have you arranged administrative support? | no | fgf |
| Do you have a Standard Operating Procedure (SOP), endorsed by Trust management and commissioners, in place? | ||
| Does your SOP cover the whole pathway, including medical management, emergency referral, imaging, and transfer? | ||
| Is your SOP reviewed and updated annually? | ||
| Do you hold regional governance meetings at least quarterly? | ||
| Do you participate in the national annual governance review? | ||
| Have you made arrangements to collect key performance indicators (KPIs)? | ||
| Have you completed KPI baseline monitoring? | ||
| Do you monitor and review KPIs? |
The MDT is the core element of the acute response which determines the intervention for the acutely unwell patient.
| Competency | Competency Met | Comments |
|---|---|---|
| Is there appropriate multidisciplinary and managerial support in place? | yes | lk |
| Have you agreed the named members of your multi disciplinary team? | yes | jhkl |
| Does your MDT include a cardiac and vascular surgeon and an interventional radiologist? | ||
| Does your MDT have a regular MDM? | ||
| Is the frequency of MDMs regular enough to allow timely decision making? | ||
| Is there a facility to hold urgent ad-hoc MDM calls 24 hours a day, seven days per week, by members of the on-call rota? | ||
| Are all patients discussed by the MDT at the MDM? | ||
| Are all decisions agreed and fully documented as clinically appropriate in the patient notes? |
The aim is to make referral by Emergency Departments simple and rapid and ensure all patients within the region are able to access the same care pathway.
| Competency | Competency Met | Comments |
|---|---|---|
| Is there always a single point of contact available, 24 hours a day, seven days per week? | yes | |
| Is the single point of contact always a consultant grade or equivalent and capable of and experienced enough to take significant clinical decisions? | yes | |
| Is there a backup always available in the event that the single point of contact is unavailable? |
"Prompt sharing of acute imaging is vital in cases of suspected aortic dissection to ensure that lifesaving treatment is not delayed and instances where repeat imaging has to be obtained are minimised to the greatest extent possible." Royal College of Radiologists
| Competency | Competency Met | Comments |
|---|---|---|
| Is there radiologist interpretation available, on-site or via a tertiary centre, 24 hours per day, seven days per week? | yes | |
| Is there an established process in place for image transfer? | yes | |
| Has this process been tested and found to be reliable? |
Clear protocols for the safe transfer of patients need to be set out and adhered to.
| Competency | Competency Met | Comments |
|---|---|---|
| Do you have an Adult Critical Care Transfer Service available to transfer all Type A and complicated Type B cases to the regional specialist centre? | yes | |
| Have arrangements been made to utilise the Adult Critical Care Transfer Service for transfer? | yes | |
| If Adult Critical Care Transfer Service is not available have you agreed transfer protocols with your regional ambulance service? | ||
| Does your protocol include arrangements for patient management during transfer? |
Patients with acute aortic dissection need to be treated in a place which can provide the appropriate level of care for their clinical needs, in a timely manner and as close to their home as is safe.
| Competency | Competency Met | Comments |
|---|---|---|
| Are all type A patients suitable for surgery operated on by a member of the MDT? | yes | |
| Are agreed protocols in place for the management of all Type B patients not requiring immediate intervention, including either transferring to the specialist centre for medical management or managed locally? | yes | |
| Are all patients with complicated Type B dissection requiring immediate intervention transferred directly to a level 2/3 critical care area within the regional specialist centre? | ||
| Are protocols in place for the management of non Type A or B patients? |
| Competency | Competency Met | Comments |
|---|---|---|
| Has an education programme been developed to describe how the regional AAD pathway will operate for all staff involved? | yes | |
| Will training be in place and rolled out before the launch of the pathway? | yes | |
| Are arrangements in place for the training to be repeated at appropriate intervals? |
There should be formal written governance arrangements between providers for day to day management and contingency plans.
| Competency | Competency Met | Comments |
|---|---|---|
| Do you have an appointed Clinical Lead? | yes | |
| Have you arranged administrative support? | yes | |
| Do you have a Standard Operating Procedure (SOP), endorsed by Trust management and commissioners, in place? | ||
| Does your SOP cover the whole pathway, including medical management, emergency referral, imaging, and transfer? | ||
| Is your SOP reviewed and updated annually? | ||
| Do you hold regional governance meetings at least quarterly? | ||
| Do you participate in the national annual governance review? | ||
| Have you made arrangements to collect key performance indicators (KPIs)? | ||
| Have you completed KPI baseline monitoring? | ||
| Do you monitor and review KPIs? |
The MDT is the core element of the acute response which determines the intervention for the acutely unwell patient.
| Competency | Competency Met | Comments |
|---|---|---|
| Is there appropriate multidisciplinary and managerial support in place? | yes | |
| Have you agreed the named members of your multi disciplinary team? | yes | |
| Does your MDT include a cardiac and vascular surgeon and an interventional radiologist? | ||
| Does your MDT have a regular MDM? | ||
| Is the frequency of MDMs regular enough to allow timely decision making? | ||
| Is there a facility to hold urgent ad-hoc MDM calls 24 hours a day, seven days per week, by members of the on-call rota? | ||
| Are all patients discussed by the MDT at the MDM? | ||
| Are all decisions agreed and fully documented as clinically appropriate in the patient notes? |
The aim is to make referral by Emergency Departments simple and rapid and ensure all patients within the region are able to access the same care pathway.
| Competency | Competency Met | Comments |
|---|---|---|
| Is there always a single point of contact available, 24 hours a day, seven days per week? | yes | |
| Is the single point of contact always a consultant grade or equivalent and capable of and experienced enough to take significant clinical decisions? | yes | |
| Is there a backup always available in the event that the single point of contact is unavailable? |
"Prompt sharing of acute imaging is vital in cases of suspected aortic dissection to ensure that lifesaving treatment is not delayed and instances where repeat imaging has to be obtained are minimised to the greatest extent possible." Royal College of Radiologists
| Competency | Competency Met | Comments |
|---|---|---|
| Is there radiologist interpretation available, on-site or via a tertiary centre, 24 hours per day, seven days per week? | yes | |
| Is there an established process in place for image transfer? | yes | |
| Has this process been tested and found to be reliable? |
Clear protocols for the safe transfer of patients need to be set out and adhered to.
| Competency | Competency Met | Comments |
|---|---|---|
| Do you have an Adult Critical Care Transfer Service available to transfer all Type A and complicated Type B cases to the regional specialist centre? | yes | |
| Have arrangements been made to utilise the Adult Critical Care Transfer Service for transfer? | yes | |
| If Adult Critical Care Transfer Service is not available have you agreed transfer protocols with your regional ambulance service? | ||
| Does your protocol include arrangements for patient management during transfer? |
Patients with acute aortic dissection need to be treated in a place which can provide the appropriate level of care for their clinical needs, in a timely manner and as close to their home as is safe.
| Competency | Competency Met | Comments |
|---|---|---|
| Are all type A patients suitable for surgery operated on by a member of the MDT? | yes | |
| Are agreed protocols in place for the management of all Type B patients not requiring immediate intervention, including either transferring to the specialist centre for medical management or managed locally? | yes | |
| Are all patients with complicated Type B dissection requiring immediate intervention transferred directly to a level 2/3 critical care area within the regional specialist centre? | ||
| Are protocols in place for the management of non Type A or B patients? |
| Competency | Competency Met | Comments |
|---|---|---|
| Has an education programme been developed to describe how the regional AAD pathway will operate for all staff involved? | yes | |
| Will training be in place and rolled out before the launch of the pathway? | yes | |
| Are arrangements in place for the training to be repeated at appropriate intervals? |
There should be formal written governance arrangements between providers for day to day management and contingency plans.
| Competency | Competency Met | Comments |
|---|---|---|
| Do you have an appointed Clinical Lead? | yes | LIVERPOOL |
| Have you arranged administrative support? | yes | |
| Do you have a Standard Operating Procedure (SOP), endorsed by Trust management and commissioners, in place? | ||
| Does your SOP cover the whole pathway, including medical management, emergency referral, imaging, and transfer? | ||
| Is your SOP reviewed and updated annually? | ||
| Do you hold regional governance meetings at least quarterly? | ||
| Do you participate in the national annual governance review? | ||
| Have you made arrangements to collect key performance indicators (KPIs)? | ||
| Have you completed KPI baseline monitoring? | ||
| Do you monitor and review KPIs? |
The MDT is the core element of the acute response which determines the intervention for the acutely unwell patient.
| Competency | Competency Met | Comments |
|---|---|---|
| Is there appropriate multidisciplinary and managerial support in place? | yes | |
| Have you agreed the named members of your multi disciplinary team? | yes | |
| Does your MDT include a cardiac and vascular surgeon and an interventional radiologist? | ||
| Does your MDT have a regular MDM? | ||
| Is the frequency of MDMs regular enough to allow timely decision making? | ||
| Is there a facility to hold urgent ad-hoc MDM calls 24 hours a day, seven days per week, by members of the on-call rota? | ||
| Are all patients discussed by the MDT at the MDM? | ||
| Are all decisions agreed and fully documented as clinically appropriate in the patient notes? |
The aim is to make referral by Emergency Departments simple and rapid and ensure all patients within the region are able to access the same care pathway.
| Competency | Competency Met | Comments |
|---|---|---|
| Is there always a single point of contact available, 24 hours a day, seven days per week? | yes | |
| Is the single point of contact always a consultant grade or equivalent and capable of and experienced enough to take significant clinical decisions? | yes | |
| Is there a backup always available in the event that the single point of contact is unavailable? |
"Prompt sharing of acute imaging is vital in cases of suspected aortic dissection to ensure that lifesaving treatment is not delayed and instances where repeat imaging has to be obtained are minimised to the greatest extent possible." Royal College of Radiologists
| Competency | Competency Met | Comments |
|---|---|---|
| Is there radiologist interpretation available, on-site or via a tertiary centre, 24 hours per day, seven days per week? | yes | |
| Is there an established process in place for image transfer? | yes | |
| Has this process been tested and found to be reliable? |
Clear protocols for the safe transfer of patients need to be set out and adhered to.
| Competency | Competency Met | Comments |
|---|---|---|
| Do you have an Adult Critical Care Transfer Service available to transfer all Type A and complicated Type B cases to the regional specialist centre? | yes | |
| Have arrangements been made to utilise the Adult Critical Care Transfer Service for transfer? | yes | |
| If Adult Critical Care Transfer Service is not available have you agreed transfer protocols with your regional ambulance service? | ||
| Does your protocol include arrangements for patient management during transfer? |
Patients with acute aortic dissection need to be treated in a place which can provide the appropriate level of care for their clinical needs, in a timely manner and as close to their home as is safe.
| Competency | Competency Met | Comments |
|---|---|---|
| Are all type A patients suitable for surgery operated on by a member of the MDT? | yes | |
| Are agreed protocols in place for the management of all Type B patients not requiring immediate intervention, including either transferring to the specialist centre for medical management or managed locally? | yes | |
| Are all patients with complicated Type B dissection requiring immediate intervention transferred directly to a level 2/3 critical care area within the regional specialist centre? | ||
| Are protocols in place for the management of non Type A or B patients? |
| Competency | Competency Met | Comments |
|---|---|---|
| Has an education programme been developed to describe how the regional AAD pathway will operate for all staff involved? | yes | |
| Will training be in place and rolled out before the launch of the pathway? | yes | |
| Are arrangements in place for the training to be repeated at appropriate intervals? |