improving care of adult patients undergoing cardiac surgery at loyola university medical center
Download
Skip this Video
Download Presentation
Improving Care of Adult Patients Undergoing Cardiac Surgery at Loyola University Medical Center

Loading in 2 Seconds...

play fullscreen
1 / 29

Improving Care of Adult Patients Undergoing Cardiac Surgery at Loyola University Medical Center - PowerPoint PPT Presentation


  • 131 Views
  • Uploaded on

Improving Care of Adult Patients Undergoing Cardiac Surgery at Loyola University Medical Center. By: Jeffrey Schwartz, MD, Assistant Professor, Department of Thoracic & Cardiovascular Surgery Derrek Davis, MD assistant Professor, Department of Anesthesiology

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Improving Care of Adult Patients Undergoing Cardiac Surgery at Loyola University Medical Center' - elle


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
improving care of adult patients undergoing cardiac surgery at loyola university medical center

Improving Care of Adult Patients Undergoing Cardiac Surgery at Loyola University Medical Center

By:

Jeffrey Schwartz, MD, Assistant Professor, Department of Thoracic & Cardiovascular Surgery

Derrek Davis, MD assistant Professor, Department of Anesthesiology

Michael Jarotkiewicz, Cardiovascular Service Line Administrator

Cardiovascular Surgery QI Team

lumc cardiovascular surgery department
LUMC – Cardiovascular Surgery Department
  • 5 Cardiovascular/Thoracic Surgeons
  • Over 600 Open Heart Pump cases/year
  • Top Center for Mitral and Aortic Valve repair and replacement
  • Over 583 Heart Transplants since 1984
  • Over 250 Lung Transplants since 1990
  • 1st successful Heart-lung transplant in Illinois (1986)
identify the problem
Identify the Problem…….

Historical trend of higher than acceptable risk adjusted complications/mortality as compared to University HealthSystem Consortium data base.

lumc cv surgical team
LUMC CV-Surgical Team

Surgeons

Nurse

Practitioners

CV

O.R.

Staff

CV

Anesthesia

2-Surgical

ICU-Staff

Surgical Outcomes

3 NEWS-Telemetry

Staff

Cardiac Rehab

Staff

Respiratory

Care

slide6

These things don’t just happen…….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
more keys to success
More Keys to Success
  • 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
solutions implementations
Solutions - Implementations
  • Aggressive Education of CV – Team
    • Physicians, Nurses, Respiratory therapists
  • Aggressive re-warming of patient (OR team)
  • Reduced utilization of sedation and improved pain management
  • Implementation of weaning & extubation protocols
solutions implementations cont
Solutions – Implementations Cont.
  • 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
  • Nurse Practitioner coordination of project
solutions example early extubation results cabg patients on a ventilator for 4 hours or less
Solutions – Example - Early Extubation ResultsCABG Patients on a Ventilator for 4 hours or less
results
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
slide15

Loyola Expected

Loyola Observed

Post CABG Patient Mortality

8

6

Mortality Rate (Percent)

4

Mean = 3.7

2

0

CY98 Q1

CY98 Q3

CY99 Q1

CY99 Q4

CY00 Q2

CY02 Q1

CY02 Q2

CY02 Q4

CY03 Q2

CY98 Q2

CY98 Q4

CY99 Q2

CY99 Q3

CY00 Q1

CY00 Q3

CY00 Q4

CY01 Q1

CY01 Q2

CY01 Q3

CY01 Q4

CY02 Q3

CY03 Q1

CY03 Q3

Results

what are our new challenges
What are our new challenges?
  • 100% Patient census and capacity issues
  • CON regulation changes in the State of Illinois
    • Competition
    • “Cherry picking”
  • “Leapfrog” – quality tracking
  • Interventional Cardiology & Gene Therapy
  • Reimbursement
hospital census 100 occupancy capacity bed availability
Hospital Census – 100% Occupancy Capacity/Bed Availability
  • Scheduling problems/Delays
  • Telemetry bed availability
  • Delays in “Rehabilitation” interventions
  • Increased ICU LOS
  • Increase in total LOS
  • Patient Satisfaction Issues
hospital census 100 occupancy bed availability what is in our control
Hospital Census – 100% Occupancy Bed Availability “What is in our control”
  • Telemetry bed availability
    • Trauma Level 1/Increased ED admissions
    • In-house “Unit renovations”
  • Increased ICU LOS/Total LOS
  • Delays in “Rehabilitation” interventions
  • Patient satisfaction
patients eligible for 1 st day post op ambulation out of bed walking 25 50 ft
Patients eligible for 1st day post-op ambulation(Out of bed walking 25-50 ft.)
  • Extubated
  • Swan-out
  • Hemodynamically Stable
ad