Aim To create a Screening Tool and Guideline for Early Detection Of Aortic Dissections at The Emergency Department of Lincoln County Hospitals.

Assessment of issue and analysis of its cause:

Literature search was performed to identify various risk factors for missed dissections and any other screening tools already available. We also reviewed the guidelines of Royal College of Emergency Medicine and Thoracic Society.

A Screening tool was created using 10 risk factors – The TRUMANSHOW

A guideline using The TRUMANSHOW was created which enabled all doctors to Fast-Track the CT Aortogram.

Methods Stickers with the mnemonic in checklist form were attached at the front of the ED notes. The stickers and the guideline were placed in the triage, RAT, majors and the resuscitation room in a TRUMANSHOW folder.

Results and strategy for improvement We did 3 cycles of PDSA during a period of 5 months. 100 CT aortograms were done which revealed 32 Acute Aortic Syndromes out of which 20 had Aortic Dissections.

The results of each PDSA cycle were shared during the Departmental morning handover sheets and every doctor and nurse were enrolled in the national THINK AORTA campaign.

Measurement of improvement The results of the 3 PDSA cycles recorded the highest early detection of Acute Aortic Syndromes in UK, during a period of 5 months.

Impact We initiated The TRUMANSHOW in the Emergency Departments of Pilgrim and Grantham Hospitals and the subsequent board meetings resulted in implementation across various departments within the trust.

The CQC report of United Lincolnshire appreciated The TRUMANSHOW as Outstanding practice towards improvement.

https://www.cqc.org.uk/sites/default/files/new_reports/AAAH1713.pdf (Open page 8 – Outstanding practice)