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The International Consortium for Evidence-Based Perfusion: Moving from Concept to Reality

The International Consortium for Evidence-Based Perfusion: Moving from Concept to Reality. Robert A. Baker 1, 2 , Timothy A Dickinson 2 , Donald S Likosky 2 , Kenneth G Shann 2 1 Flinders Medical Centre, Bedford Park, South Australia.

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The International Consortium for Evidence-Based Perfusion: Moving from Concept to Reality

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  1. The International Consortium for Evidence-Based Perfusion: Moving from Concept to Reality Robert A. Baker1, 2, Timothy A Dickinson2, Donald S Likosky2, Kenneth G Shann2 1Flinders Medical Centre, Bedford Park, South Australia. 2Executive, International Consortium for Evidence Based Perfusion

  2. Potential Conflicts of Interest • Research Support • Terumo, National Heart Foundation, Somanetics, Lunar Innovations • Travel and Conference Support • Terumo, Medtronic, Cellplex, Bayer • Perfusion Downunder Organisation • Deputy Chair • Chair of the PDU Collaboration

  3. Outline • What is the ICEBP? • Structure and Progress • How and Why to get involved.

  4. What is the ICEBP? • www.icebp.org

  5. Mission Statement • The International Consortium for Evidence-Based Perfusion (ICEBP) partners and • collaborates with perfusion societies, professional medical societies, and interested clinicians, to improve continuously the delivery of care and outcomes for our patients. • Vision of the ICEBP • To achieve this mission, we will • Evaluate current practice through a dedicated international perfusion registry. • Develop and publish evidence based guidelines, and support their integration • into clinical practice. • Identify gaps in the medical literature and empower clinical teams to conduct • research in areas where evidence is lacking. • Identify gaps between current and evidence-based clinical practice to promote • the improvement in patient care. • Mission Statement • The International Consortium for Evidence-Based Perfusion (ICEBP) partners and • collaborates with perfusion societies, professional medical societies, and interested • clinicians, to improve continuously the delivery of care and outcomes for our patients. • Vision of the ICEBP • To achieve this mission, we will • Evaluate current practice through a dedicated international perfusion registry. • Develop and publish evidence based guidelines, and support their integration • into clinical practice. • Identify gaps in the medical literature and empower clinical teams to conduct • research in areas where evidence is lacking. • Identify gaps between current and evidence-based clinical practice to promote • the improvement in patient care.

  6. International Consortium for Evidence-Based Perfusion Communication Subcommittee Pediatric Process Improvement Subcommittee Clinically-Based Registry Subcommittee Evidence-Based Guideline Writing Subcommittee Steering Committee Scientific Sessions Subcommittee Educational Subcommittee Adult Process Improvement Subcommittee Research Development Subcommittee

  7. Current practice Evidence-based practice

  8. Current practice Registry Guidelines Evidence-based practice

  9. Current practice Communications CQI Registry Research Education Guidelines Scientific Sessions Evidence-based practice

  10. Current practice Members Members Communications CQI Registry Research Education Guidelines Scientific Sessions Evidence-based practice Members Members

  11. Communications Subcommittee

  12. Website – www.icebp.org

  13. Website – Committee Pages

  14. Committee Sites

  15. Committee Sites

  16. Website – Meetings / Events

  17. Tools and Tips

  18. Newsletters

  19. www.icebp.org

  20. Scientific Sessions Planning Subcommittee

  21. Scientific Subcommittee • Mission: • Develop and organize an annual scientific meeting focused on meeting the goals of the ICEBP mission statement. The scientific meeting will cover topics related to all other subcommittees. In addition, the subcommittee will be charged with examining areas into which the meeting can grow to allow demonstration of sustained improvement in the care provided to patients.

  22. Scientific Subcommittee • Mission: • Develop and organize an annual scientific meeting focused on meeting the goals of the ICEBP mission statement. The scientific meeting will cover topics related to all other subcommittees. In addition, the subcommittee will be charged with examining areas into which the meeting can grow to allow demonstration of sustained improvement in the care provided to patients.

  23. Scientific Subcommittee • Mission: • Develop and organize an annual scientific meeting focused on meeting the goals of the ICEBP mission statement. The scientific meeting will cover topics related to all other subcommittees. In addition, the subcommittee will be charged with examining areas into which the meeting can grow to allow demonstration of sustained improvement in the care provided to patients.

  24. Scientific Subcommittee • Mission: • Develop and organize an annual scientific meeting focused on meeting the goals of the ICEBP mission statement. The scientific meeting will cover topicsrelated to all other subcommittees. In addition, the subcommittee will be charged with examining areas into which the meeting can grow to allow demonstration of sustained improvement in the care provided to patients.

  25. Scientific Subcommittee • Mission: • Develop and organize an annual scientific meeting focused on meeting the goals of the ICEBP mission statement. The scientific meeting will cover topics related to all other subcommittees. In addition, the subcommittee will be charged with examining areas into which the meeting can grow to allow demonstration of sustained improvement in the care provided to patients.

  26. Best Practices in Perfusion • Two Successful Meetings: 2006 Seattle, Washington (USA) 2007 Montreal, Quebec (CAN)

  27. Dwayne Jones, CPC, CCP, RN (CAN) Christos Calaritis, BSc, CPC, CCP (CAN) Gordon R. DeFoe, CCP Timothy A. Dickinson, MS (Chair) (USA) Robert C. Groom, MS, CCP (USA) Deborah Hubble, CCP (USA) Donald S. Likosky, PhD (USA) Jeffrey B. Riley, MHPE, CCT (USA) Dirck A. Rilla, LP, CCP (USA) David J. Rosinski, CCP (USA) Kenneth G. Shann, CCP (USA) Alfred H. Stammers, MSA, CCP (USA) Robert Baker, PhD, CCP (Aus) Planning Committee - 2007

  28. Program Highlights - 2007 • ICEBP guideline subcommittee update • Quality improvement skills training • The World Society for Pediatric and Congenital Heart Surgery –Dr. Tchervenkov • Adult & pediatric registries • Public reporting and transparency • Credentialing of perfusionists as a best practice • Abstracts on key aspects of best practice • Audience Response System utilized

  29. Australia Belgium Canada Japan Germany Netherlands New Zealand Pakistan Saudi Arabia Spain Sweden United Kingdom United States International Attendees - 2007

  30. Bayer Pharmaceuticals The Medicines Company Terumo Cardiovascular Maquet-Dynamed Inc. Somanetics Corporations CAS Medical Systems Gish Biomedical, Inc. Global Blood Resources Luna Innovations Medtronic, Inc. Quest Medical, Inc. Rocky Mountain Research Sorin Group Spectrum Medical Manufacturer Support - 2007

  31. Best Practices – 2008 • Date: Early October 2008 • Location: Southern USA • San Antonio • Galverston • Dallas

  32. Paediatric Subcommittee

  33. The Opportunity “The professions caring for patients with congenital heart disease have the unique opportunity to create the first comprehensive international database for a medical subspecialty.” Jacobs JP. International Congenital Heart Disease Nomenclature: Introduction to Mapping and Computer Based Mapping Solutions. Presented at The International Summit on Nomenclature for Congenital Heart Disease at The Third World Congress of Pediatric Cardiology and Cardiac Surgery, Toronto, Canada, May 27, 2001.

  34. Meaningful Multi-institutional Outcomes Analysis Requirements - Accomplishments • Common Language = Nomenclature • Mechanism of Data Collection (Database - Registry) • Mechanism of Evaluating Case Complexity • Mechanism to Verify Data Validity and Accuracy • Collaboration Between Subspecialties

  35. Multi-Societal Database Committee for Pediatric and Congenital Heart Disease • The STS Congenital Database Taskforce • The EACTS/ECHSA Congenital Database Committee headed by Bohdan Maruszewski • The STS Congenital Database Taskforce Core Users Group headed by Hal Walters • The STS Congenital Database Data Verification Subcommittee headed by Dave Clarke • The Aristotle Project headed by Francois Lacour Gayet • The Multi-Center Panel of Experts for Cardiac Surgical Outcomes headed by Kathy Jenkins • The Congenital Cardiac Anesthesia Society (CCAS) Database headed by David Vener • The Joint Council of Congenital Heart Disease (JCCHD) headed by Gerard Martin, MD and representing the American Heart Association and the American College of Cardiology • The Association of European Pediatric Cardiology Nomenclature Committee headed by Rodney Franklin

  36. Multi-Societal Database Committee for Pediatric and Congenital Heart Disease • The Pediatric Cardiac Intensive Care Society (PCICS) • The VPS (Virtual Pediatric Intensive Care Unit Database System) • The International Consortium for Evidence Based Perfusion (ICEBP) • The International Working Group for Mapping and Coding of Nomenclatures for Paediatric and Congenital Heart Disease (Nomenclature Working Group – NWG) headed by Christo Tchervenkov • The World Society for Pediatric and Congenital Heart Disease headed by Christo Tchervenkov • Center for Quality Improvement and Patient Safety of Agency for Healthcare Research and Quality (AHRQ) of the United States Department of Health and Human Services • Birth Defect Branch of the Centers for Disease Control and Prevention (CDC) • The National Association of Children's Hospitals and Related Institutions (NACHRI ) • The National Quality Forum (NQF)

  37. Multi-Societal Database Committee for Pediatric and Congenital Heart Disease • ICEBP Pediatric Committee is now a member • Attend 3 meetings per year • Involved with all projects • Implementation of perfusion specific variables into STS Congenital heart surgery database

  38. Complications Project • In congenital heart surgery, mortality in 2006 is 4%. In order to assess better quality of care involving the remaining 96% of patients, we must agree on universally accepted definitions of morbidity. • Not all complications are caused by medical error and not all medical error results in complications. • Not all complications are medical negligence or medical malpractice. • Many subtypes of complications exist.

  39. Complications Project • ICEBP Pediatric Committee responsible for CPB, ECLS, and VAD complication list • Biweekly conference calls • E-mail • Multiple revisions • Creation of manuscript to be submitted to Cardiology in the Young alongside other organ system complication lists (>1000)

  40. Ongoing Initiatives • Collaborative Database initiatives with the: • Congenital Cardiac Anesthesia Society (CCAS) • Joint Council of Congenital Heart Disease (JCCHD), representing ACC and AHA • Pediatric Cardiac Intensive Care Society (PCICS) • STS Regional Congenital Database Reports • Data Verification Site Visit Project • Ongoing collaborative research to • validate the Aristotle Basic Complexity Score • with the developers of both the Aristotle Basic Complexity Score (ABC Score) and the Risk Adjustment for Congenital Heart Surgery (RACHS-1) methodology with the goal of unifying these two systems. • Complications Project

  41. Registry SubcommitteeInternational Perfusion Registry

  42. Perfusion Fields in the STS Registry

  43. What Might Be Some Items on My Data Form? • Preoperative factors • Age, comorbid conditions • Intraoperative factors • Duration of cardiopulmonary bypass • Prime volume • Outcome Variables • Death x acuity, return to the OR for bleeding Traditional

  44. What Might Be Some Items on My Data Form? • Preoperative factors • Age, comorbid conditions • Intraoperative factors • Duration of cardiopulmonary bypass • Prime volume • Outcome Variables • Death x acuity, return to the OR for bleeding Traditional What you Can Vary • Process variables • Use of cell processing • Use and type of arterial line filter • Type of circuit • Prevention of air entrainment • Highest blood glucose level during bypass • Nadir Hct - by gender

  45. Guiding Principles • Quality over quantity • Definitions, definitions, definitions • Validation of case count and status • Smart registry • Center Thumbprint • Assist in submissions to other registries • Software independent • Cross match to STS and PDUCDB

  46. How We Can Learn from Each Other One center’s experience What is unique about these centers? TAKE HOME POINTS: The future depends on data collection, data feedback, and benchmarking

  47. Areas of Focus • Patient demographics (to adjust for potential patient-level confounders) • Compliance with perfusion guidelines that were published in JTCVS (amend the list as the ICEBP publishes guidelines) • Cell processing and filtration • Renal Management • Factors influence low EF (among patients with normal EF)

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