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Thomas Varghese Jr. MD, MS, FACS

Join SUSP Affinity Groups! Learn from experts and other SUSP hospital teams who are working on what you’re working on . Click this link SUSP Affinity Group Registration Link to register for an affinity group by Tuesday, May 20 th ! . Thomas Varghese Jr. MD, MS, FACS.

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Thomas Varghese Jr. MD, MS, FACS

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  1. Join SUSP Affinity Groups!Learn from experts and other SUSP hospital teams who are working on what you’re working on Click this link SUSP Affinity Group Registration Link to register for an affinity group by Tuesday, May 20th!

  2. Thomas Varghese Jr. MD, MS, FACS

  3. Objectives of Strong For Surgery • Identify and evaluate evidence-based practices to optimize the health of patients prior to surgery • Outline key factors in pre-surgical care that can improve post-operative outcomes • Apply quality improvement tools to implement best practices toward optimizing patient health

  4. Funding • Agency for Healthcare Research and Quality • Life Sciences Discovery Fund • Nestle HealthCare Nutrition • UW Patient Safety Innovation Program • UW Department of Surgery

  5. Our Shared Project Goals • To achieve significant reductions in surgical site infection and surgical complication rates • To achieve significant improvements in safety culture

  6. Why is Your SUSP Work Important? • 1 in 25 people will undergo surgery • 7 million (25%) complications follow in-patient surgeries • 1 million (0.5 – 5%) deaths follow surgery • 50% of all hospital adverse events are linked to surgery AND are avoidable

  7. Problems Every year there are 210,000 Preventable Deaths • $30 billion per year J Patient Safety Sept 2013; 9(3): 122-128

  8. Problems Every year there are 210,000 Preventable Deaths • ½ associated with an operation • $30 billion per year 1 in 4 colon resections readmitted within 90 days • $300 million per year Soft Tissue Surgical Site Infections • $3 billion in direct costs J Patient Safety Sept 2013; 9(3): 122-128 Wick EC, et al. 2011; 54(12):1475-1479 Eappen S JAMA. 2013;309(15):1599-1606

  9. It takes an average of 17 years before new knowledge from randomized clinical trials is incorporated into widespread clinical practice! JAMA 1999; 282: 1458-1465; Health Professions Education 2003 J Am Med Inform 2001; 8(4):398-399 N Engl J Med 2003; 348:2635-2645

  10. Healthcare System in Washington State QI Performance Surveillance Research and Development Translation of Research into Practice

  11. Clinician-led QI using clinical data • Focus on quality and cost-effectiveness data • Impacts behavior through: • Benchmarking • Education • Standard orders • Checklists

  12. BeforeElective Colorectal Resection, CHARS 2000-2003

  13. After Elective Colorectal Resection CHARS 2006-2009

  14. Clinician Offices Clinical Practice Partners Evidence Generation Hospitals Long-term Care Facilities Dissemination & Implementation

  15. Patient Voices Stakeholder Input Healthcare Data Clinician Offices Clinical Practice Partners Evidence Generation Hospitals Long-term Care Facilities Dissemination & Implementation

  16. Patient Voices Stakeholder Input Healthcare Data Clinician Offices Clinical Practice Partners Evidence Generation Hospitals Long-term Care Facilities Dissemination & Implementation

  17. Focus on Decision Making PATIENT DOCTOR’S OFFICE OPERATING ROOM

  18. PATIENT DOCTOR’S OFFICE OPERATING ROOM

  19. Focus on Decision Making in Clinic PATIENT DOCTOR’S OFFICE OPERATING ROOM

  20. What is Strong for Surgery? Public health campaignfocused on surgeons, patients and other important stakeholders • Interactive tools to help optimize patients prior to surgery   • Messaging • Surveillance, data feedback, public reporting

  21. Current Checklists Blood Sugar • Diabetes risk screening • Blood sugar control screening • Perioperative glucose management Nutrition • Screening for malnutrition • Albumin test for risk stratification • Immunonutrition supplementation Smoking • Smoking habits and history • Establish and document quit plan Medications • Identify drugs that could cause bleeding and cardiac risks • Herbal medication reconciliation See full version of the checklists at www.strongforsurgery.org

  22. Why Blood Sugar? • Hypergycemia doubles the risk of SSI • In some studies 47% of hyperglycemic episodes were in nondiabetics! Latham. InfContrHospEpidemiol. 2001;22:607 Dellinger. InfContrHospEpidemiol. 2001;22:604

  23. Why Blood Sugar? • Hypergycemia doubles the risk of SSI • In some studies 47% of hyperglycemic episodes were in nondiabetics! • 470 million people worldwide will have prediabetes by 2030 • 35% of US adults older than 20 yrs of age and 50% greater than 65 years had prediabetes in 2005-2008 Latham. InfContrHospEpidemiol. 2001;22:607 Dellinger. InfContrHospEpidemiol. 2001;22:604 Lancet 2012; 2279-2290 2011 US Department of Health and Human Services

  24. Why Blood Sugar? • > 65 years • 1 in 4 will have diabetes • 2 in 4 are prediabetic 2011 US Department of Health and Human Services

  25. Why Medications? • Some medications and herbal remedies increase risk of bleeding • Echinacea, Garlic, Ginkgo, Ginseng, Kava,Saw Palmetto, St. John’s Wort, Valerian ↑ risk • Aspirin can be safely continued Chest 2012; 141:e326S-e350S; JAMA 2008; 300(24):2867-2878; Ann Surg 2012; 255(5):811-819

  26. Why Medications? • Some medications and herbal remedies increase risk of bleeding • Echinacea, Garlic, Ginkgo, Ginseng, Kava,Saw Palmetto, St. John’s Wort, Valerian ↑ risk • Aspirin can be safely continued • Beta-blocker continuation associated with fewer cardiac events and mortality Chest 2012; 141:e326S-e350S; JAMA 2008; 300(24):2867-2878; Ann Surg 2012; 255(5):811-819; Arch of Surg 2012; 147(5):467-473

  27. Why Nutrition? • Malnutrition is prevalent in surgical patients • Best determinant of surgical outcome

  28. Why Nutrition? • Malnutrition is prevalent in surgical patients • Best determinant of surgical outcome • Modifiable with appropriate intervention • Immunonutrition may improve recovery

  29. SCOAP: Albumin & ComplicationsElective colon/rectal procedures 2011

  30. Surgery and trauma patients are immune suppressed making them more susceptible to infection due to arginine depletion. Arginine Depletion Risk of INFECTION T-Cell Dysfunction Popovich 2006; McClave 2009; Zhu 2010

  31. Surgery and trauma patients are immune suppressed making them more susceptible to infection due to arginine depletion. Arginine Depletion Risk of INFECTION T-Cell Dysfunction Immune- modulating formulas  Arginine + Ω-3 fatty acids + Nucleotides 5 to 7 day regimen, 3 times daily Popovich 2006; McClave 2009; Zhu 2010

  32. Literature Review • Systematic Review • N=3,438 • 35 studies focused on elective surgery • Procedure types • 25 GI: 18 upper; 2 lower; 5 mixed • 10 non-GI • 23 – used arginine-based supplements • Pre-Op Use: ↓ Infectious complications 43% Drover JW, et al. JACS 2011; 212 (3):385-399

  33. Why Smoking? Adjusted Odds Ratio Complications Associated with Smoking Mary T Hawn et al., “The Attributable Risk of Smoking on Surgical Complications,” Annals of Surgery 254, no. 6 (December 2011): 914–920.

  34. Post-Operative Outcomes by Pack-Years Smoked Mary T Hawn et al., “The Attributable Risk of Smoking on Surgical Complications,” Annals of Surgery 254, no. 6 (December 2011): 914–920.

  35. Checklists

  36. Raising Awareness Changing Practice

  37. Raising Awareness

  38. Public Health Campaign • Understanding clinic and patient needs • Checklists • Tracking outcomes • Strategic partnerships • Community Engagement • Outreach events • Website content www.strongforsurgery.org

  39. Publications OR MANAGER

  40. By Laura Landro

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