Code Aorta Protocol: Implementation and Evaluation of a Novel Multidisciplinary Protocol to Improve Diagnostic and Therapeutic Efficiency in Aortic Catastrophes

Acute aortic catastrophes, including aortic dissection and ruptured aneurysm, are time-sensitive emergencies associated with high mortality. In many health systems, delays in diagnosis and treatment arise from structural fragmentation, including lack of standardized pathways, variable access to imaging and specialty consultation, and inconsistent coordination across departments and sites. These structural gaps lead to inefficient processes of care, such as delayed recognition of atypical presentations, prolonged time to definitive imaging, and delayed surgical consultation, resulting in worse clinical outcomes. To address these deficiencies, we implemented a standardized, multidisciplinary “Code Aorta” protocol designed to align system structure and care processes across a multi-site health system. We evaluated its association with improvements in key process-based quality metrics related to timeliness of diagnosis and management.

This retrospective observational study included all emergency department (ED) encounters across five sites of a quaternary care academic, urban health system from March–July 2024 in which the Code Aorta protocol was activated. Patients undergoing CT angiography (CTA) for suspected aortic pathology without activation served as controls. Process metrics and diagnostic yield were compared between the two groups.

PRELIMINARY RESULTS: Of 1,053 patients undergoing CTA, 58 (5.5%) had Code Aorta activations. Confirmed acute aortic pathology was present in 22.4% of activations versus 5.8% of non-activations. Compared with non-activation cases, Code Aorta activations demonstrated shorter average times from ED arrival to CT start (1.2h vs 2.5h), CT read (2.0h vs 3.6h), surgical consult (0.7h vs 3.6h), and disposition (4.5h vs 5.4h). Among activation cases with confirmed aortic pathology, 46.2% required urgent surgery, with a median CT read-to-OR interval of 69 minutes.

Implementation of a multidisciplinary “Code Aorta” protocol significantly reduced key time intervals from presentation to diagnosis and intervention of aortic catastrophes and improved diagnostic yield of imaging. Standardized, system-wide activation pathways can enhance efficiency, coordination, and quality of care for patients with life-threatening vascular emergencies.