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Improving Care of Adult Patients Undergoing Cardiac Surgery

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

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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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