improving care of adult patients undergoing cardiac surgery n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Improving Care of Adult Patients Undergoing Cardiac Surgery PowerPoint Presentation
Download Presentation
Improving Care of Adult Patients Undergoing Cardiac Surgery

Loading in 2 Seconds...

play fullscreen
1 / 15

Improving Care of Adult Patients Undergoing Cardiac Surgery - PowerPoint PPT Presentation


  • 123 Views
  • Uploaded on

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

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' - jana


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
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

Care

identify the problem
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.

.

solutions implemented
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
solutions example early extubation protocol
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
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
slide8

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
results1
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
slide11
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

cardiac surgery pre procedure co morbidity cy 2001
Cardiac SurgeryPre-procedure Co-morbidity CY 2001

Higher percent

of co-morbidities

indicates patients

who were sicker

prior to surgery

what are our ongoing challenges
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