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Making Surgery Safer:

Project Team Membership. AnesthesiaCardiologyGeneral SurgeryOrthopaedicsPharmacyPrimary CareQuality Resource ManagementSurgical ServicesSurgical Admitting CenterUrology4ICU 5 SouthCenter for Clinical Effectiveness. . Opportunity Statement. There is an opportunity to reduce the risk of postoperative myocardial infarction in high-risk patients undergoing major surgical procedures. The objectives of this project are:To ensure that all high-risk patients receive perioperative beta9458

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Making Surgery Safer:

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    1. Making Surgery Safer: Preventing Postoperative Myocardial Infarction

    2. Project Team Membership Anesthesia Cardiology General Surgery Orthopaedics Pharmacy Primary Care Quality Resource Management Surgical Services Surgical Admitting Center Urology 4ICU 5 South Center for Clinical Effectiveness

    3. Opportunity Statement There is an opportunity to reduce the risk of postoperative myocardial infarction in high-risk patients undergoing major surgical procedures. The objectives of this project are: To ensure that all high-risk patients receive perioperative beta-blocker therapy To reduce the incidence of postoperative myocardial infarction in high-risk patients

    4. Most Likely Causes Perioperative beta-blockers have not been routinely given at LUHS because: This practice has been only recently identified in the literature as an approach to reduce cardiac complications Lack of awareness of new literature by some LUHS physicians Variation in patient screening and physician ordering practices

    5. Implementation of the LUHS Perioperative Beta-Blocker Protocol Implementation for elective cases: Urology 12/02 General Surgery 4/03 Vascular 8/03 Complex spine procedures 1/04 Orthopaedics 10/04 All remaining services 1/05 Revised the protocol based on patient response and provider feedback

    6. Project Activities Improved screening process in Preadmission testing Improved visibility and access to the protocol Protocol orders added to existing standing orders when appropriate Education to attending physicians, residents, nurses, and pharmacists Two staff RN’s joined the project committee

    7. LUHS Postoperative Myocardial Infarction Rates

    8. Analysis of Results More than 800 patients have completed the protocol. 1.9% rate of postoperative myocardial infarction No mortality Protocol implementation to all surgical services is expected to favorably impact the results

    9. Next Steps Ongoing education to improve visibility of the protocol Identify potential for EPIC prompts Ongoing comparison with UHC hospitals Expand project to hospitalized patients undergoing non-elective surgeries

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