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Improving Care of Adult Patients Undergoing Cardiac Surgery

Learn how LUMC's CV Surgical Team improved outcomes for adult cardiac surgery patients. Discover strategies, results, and ongoing challenges faced. The team implemented innovative solutions focusing on early ambulation, extubation protocols, and improved patient care coordination.

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Improving Care of Adult Patients Undergoing Cardiac Surgery

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  1. Improving Care of Adult Patients Undergoing Cardiac Surgery LUMC CV-Surgical Team

  2. LUMC CV-Surgical Team Surgeons Nurse Practitioners CV O.R. Staff CV Anesthesia 2-Surgical ICU-Staff Positive Surgical Outcomes 3 NEWS-Telemetry Staff Cardiac Rehab Staff Respiratory Care

  3. Identify the Problem……. Historical trend of coronary artery by-pass (CABG) surgery complication and mortality rates that were higher than desired, even after the data was adjusted for the severity of the patients’ illness. .

  4. Solutions Implemented • Aggressive Education of CV – Team • Physicians, Nurses, Respiratory Therapists • Implementation of standing orders and integration into Electronic Medical Record (EMR) and Physician Order Entry (POE) Systems • Monitoring and sharing of results with all team members • Early ambulation after surgery • Early extubation protocol • Nurse Practitioner coordination of project

  5. Solutions - Example:Early Extubation Protocol • Extubation protocol was developed to establish common team expectations • Patients were re-warmed after surgery by the OR team • Use of sedation medication was reduced so that patients were more alert • Pain management was improved

  6. Solutions – Example - Early Extubation ResultsCABG Patients on a Ventilator for 4 hours or less

  7. Solutions – Example - Early Extubation ResultsUHC CABG Time on a Ventilator

  8. Keys to Success • Multidisciplinary QI Team • DRG Specific Cost Initiatives • Post-op Primary CV Surgical Service • Dedicated Nurse Practitioner Model • Consolidated Patient Placement 3W Telemetry • Dedicated Anesthesiology – 24 Hr. ICU Post-Operative Patient Management • Early Awareness, Recognition and Prevention of Post-Op Complications • Ventilator Weaning/Early Extubation Protocol • Resident Accountability

  9. Results

  10. Results • Significant improvement • from 4Q 1999 – 3Q 2000 to 3Q – 4Q 2001 • Mean LOS – 9.49 Days • Mean Cost per Case - $24,511 • Mortality – 0.6% (0/E 0.15) identified as best performer in institutions performing >100 CABG procedures

  11. Coronary Artery By-Pass SurgeryLength of Stay, Case Cost and Mortality Observed to Expected (O/E) Ratios O/E Ratio of less than 1.0 is desirable

  12. Coronary Artery By-Pass Surgery Risk Adjusted Operative Mortality Trends

  13. Cardiac SurgeryPre-procedure Co-morbidity CY 2001 Higher percent of co-morbidities indicates patients who were sicker prior to surgery

  14. Cardiac SurgeryPre-procedure Co-morbidity CY 2001

  15. What are our ongoing challenges? • Managing 100% patient census and capacity issues • Monitoring quality outcomes • Keeping abreast of new technology in cardiovascular surgery • Maintaining cost effectiveness • Meeting the expectations of our patients

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