Spinal Cord Protection for Thoracic Aortic Surgery

Project Details

  • Departments/Divisions: Anaesthesiology, Vascular Surgery, Cardiac Surgery
  • Physician Leads: Dr. Brian Gregson, Anaesthesiology
  • Budget: $8,783.00

About the Project

One of the most serious complications to come from thoracic aortic procedures is paraplegia and spinal cord ischemia. While all clinicians endeavour to provide the best possible advice to reduce the risk of these complications, to date there has not been a protocolized approach. This meant physicians were manually writing orders, with some variability. The opportunity was ripe for modernization incorporating newer evidence. Dr. Brian Gregson aimed to build a care pathway, with physician input and direction, to provide standardization around these procedures, manage expectations for all those involved in care, and improve patient care.

This effort involved considered engagement with many different stakeholders, including cardiac anesthesiology, vascular surgery, cardiac surgery, pharmacists, OR staff, and CVU staff. Though this number of vested interests could have been a complication, Dr. Gregson said it was the opposite: “These are groups that work together regularly. People seemed just happy for someone to do this work of getting an order set on paper”.

Working closely with CVU Educator Aaron Renyard, Dr. Gregson established a care pathway and clinical order set (COS) for all patients undergoing thoracic aortic surgery, whether open or endovascular. The team is in the process of transferring this pathway onto an easy to follow infographic, to be shared with all members of the care team.

Speaking about the process, Dr. Gregson reflected on the time and complexity involved in creating the order set, particularly in light of stretched capacity for the Island Health Clinical Order Set Coordinator. This hasn’t diminished his enthusiasm for pursuing follow up projects: “Now that I’ve demystified the process of formalizing a COS, there are other processes that could use similar standardization”.

We are thankful to Dr. Gregson, Aaron Renyard, and the CVU team for undertaking this important work!

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