Systematic Quality Improvement Protocol Reduces Mortality in Acute Mesenteric Ischemia: A Decade of Multidisciplinary Experience

Background Acute mesenteric ischemia (AMeI) has mortality rates exceeding 50%, largely due to diagnostic delays and care fragmentation. We implemented a multidisciplinary quality improvement protocol to reduce time-to-diagnosis and standardize treatment. Methods We analyzed outcomes before (2012-2017) and after (2018-2024) implementing a quality improvement initiative at our center. The protocol included: (1) direct specialist activation, (2) mandatory <6-hour CT completion, (3) immediate angiography for equivocal cases, and (4) an endovascular-first approach. Results Among 37 patients (mean age 77.8 years), the quality improvement initiative reduced median ER-to-CT time from 8.5 to 2.9 hours and increased 6-hour completion rates from 50.0% to 68.8%. Endovascular-first 30-day survival improved from 53.8% to 76.9% (p<0.05). Technical success reached 77.8% with zero procedural complications. Conclusions Systematic quality improvement in AMeI care significantly reduces diagnostic delays and improves survival. This protocol demonstrates how structured care pathways can enhance outcomes in time-sensitive vascular emergencies.