The Perfusion Downunder Collaboration: Leveraging Our Data

1. The Perfusion Downunder Collaboration: Leveraging Our Data Perfusion Downunder Collaboration Rob Baker* & Richard Newland On behalf of the Perfusion Downunder Collaboration *Director Cardiac Surgery Research and Perfusion Flinders Medical Centre and Flinders University, Bedford Park, South Australia.

2. COI’s / Disclosures • Travel and Research support in the last 12 months • Medtronic • Cellplex Pty Ltd • Terumo Corporation

4. Perfusion Downunder Collaboration A collaborative network of perfusion and interested researchers, who share the commitment to cooperation and collaboration in the pursuit of excellence in perfusion.

5. Who is the PDUC?

6. PDUC Mission Statement To foster and grow high quality research in the perfusion sciences by the establishment and maintenance of a prospective data set on cardiac surgical procedures performed in centres throughout Australia and New Zealand.

7. Perfusion Downunder Collaboration Understand and quantify our practice Quality improvement Research

9. PDU Collaborative Database HLM software (DMS or JOCAP) PDU Transfer Database PDU Database De-identified Central PDU Database

10. 2007 - Current: Recruitment & Data

11. Dataset (n=7769) • Total records imported (April 2011) 294 after censor date 111 missing date of surgery (n=7364) • Jan 2007 - Feb 2011 111 missing age 22 age <18 (n=5465) • Adult isolated CABG/ Valve/ Valve + CABG

12. Dataset • Demography • Age, Sex, Weight etc • Clinical • Urgency, Clinical history etc • Perfusion and quality indicators • Bypass time, management, monitoring etc • Electronic data variables • (continuous and calculated) • Procedure • Number of grafts, valve replacement etc • Outcomes • Length of stay, complications etc

14. Risk Factors: Core Procedures

16. We are interested in what is not in other databases (ie Perfusion variables) and relating practices to outcomes:

17. Components of the Circuit Pump Type Venous Reservoir Type

18. Biopassive circuit coating Circuit coating:type Coated circuit use Oxygenator coating

19. Monitoring Cerebral oximetry Blood gas monitoring BIS monitoring

20. Clinical incidents Near misses Incidents PIRS reports Accidents reported to PIRS: 56.5% Near misses reported to PIRS: 37%

21. Exposure to RBC transfusion (Cummulative %) 23

22. Blood management utilisation Overall By site

23. ICU blood loss 1st 4 hours Total (n=2890, 384 cases missing data) (introduced nov 2007. n=2259, 393 cases missing data)

24. Continuous and Electronic data • Quality indicators • haemoglobin <70 g/dl • blood glucose > 10 mmol • arterial temperature >37C for >2 min • arterial pressure < 40 mmHg > 5 minutes • cardiac index < 1.6 l/min/m2 > 5 minutes • venous saturation < 60% > 5 minutes • pCO2 < 35 or > 45 mmHg • pO2 <100 mmHg • Multi-insitutional Level

25. Art P <40 mmHg >5 min

26. CI <1.6 l/min/m2 >5 min

28. Defining benchmarking? • “Concept of using a structured method of quality measurement and improvement” • “Process of measuring performance using one or more specific indicators to compare activity with others”

29. Methods - Benchmarks • Quality Indicators • Chosen • Evidence / guidelines • Consensus • arterial outlet temperature > 37oC • blood glucose < 4 or > 10 mmol/l • pCO2 <35 or >45 mmHg • Achievable Benchmarks of Care • Weissman et al 1999 J EvalClinPract 5;269-281

30. Calculating benchmarks with paired-mean method • Calculate adjusted performance fraction (APF) • APF = (x + 1)/(d + 2) • Rank centres in order of performance for a specific quality indicator • Create subset comprising top 10% best-performing centres, add centres until a subset represents at least 10% of the entire dataset is established • Calculate benchmark based on subset as follows: • Total number of patients in subset receiving recommended intervention • Total number of patients in subset Weissman et al 1999 J Eval Clin Pract 5;269-281

31. Arterial pCO2 < 35 or > 45 mmHg 20.3%

32. Arterial pCO2 < 35 or > 45 mmHg

33. Arterial pCO2 < 35 or > 45 mmHg

34. Arterial outlet temperature > 37oC Percentage of Patients 6.2%

35. Factors

36. Arterial outlet temperature > 37oC

37. Cummulative site performance

39. Thankyou