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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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lumc cv surgical team
LUMC CV-Surgical Team












Surgical Outcomes

3 NEWS-Telemetry


Cardiac Rehab




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

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
  • 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
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