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Making Surgery Safer:

Making Surgery Safer:. Preventing Postoperative Myocardial Infarction. Project Team Membership. Anesthesia Cardiology General Surgery Orthopaedics Pharmacy Primary Care Quality Resource Management Surgical Services Surgical Admitting Center Urology 4ICU 5 South

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Making Surgery Safer:

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  1. Making Surgery Safer: Preventing Postoperative Myocardial Infarction

  2. Project Team Membership • Anesthesia • Cardiology • General Surgery • Orthopaedics • Pharmacy • Primary Care • Quality Resource Management • Surgical Services • Surgical Admitting Center • Urology • 4ICU • 5 South • Center for Clinical Effectiveness

  3. Opportunity Statement There is an opportunity to reduce the risk of postoperative myocardial infarction in high-risk patients undergoing major surgical procedures. The objectives of this project are: • To ensure that all high-risk patients receive perioperative beta-blocker therapy • To reduce the incidence of postoperative myocardial infarction in high-risk patients

  4. Most Likely Causes Perioperative beta-blockers have not been routinely given at LUHS because: • This practice has been only recently identified in the literature as an approach to reduce cardiac complications • Lack of awareness of new literature by some LUHS physicians • Variation in patient screening and physician ordering practices

  5. Implementation of the LUHS Perioperative Beta-Blocker Protocol • Implementation for elective cases: • Urology 12/02 • General Surgery 4/03 • Vascular 8/03 • Complex spine procedures 1/04 • Orthopaedics 10/04 • All remaining services 1/05 • Revised the protocol based on patient response and provider feedback

  6. Project Activities • Improved screening process in Preadmission testing • Improved visibility and access to the protocol • Protocol orders added to existing standing orders when appropriate • Education to attending physicians, residents, nurses, and pharmacists • Two staff RN’s joined the project committee

  7. LUHS Postoperative Myocardial Infarction Rates 0.018 Project Started 0.016 0.014 Loyola Mean 0.012 0.010 0.008 0.006 0.004 UHC Population Mean 0.002 0.000 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 1999 1999 1999 1999 2000 2000 2000 2000 2001 2001 2001 2001 2002 2002 2002 2002 2003 2003 2003 2003 2004 2004 2004 Loyola’s postoperative myocardial infarction rate for all major surgical procedures is improving, but higher than the UHC mean

  8. Analysis of Results • More than 800 patients have completed the protocol. • 1.9% rate of postoperative myocardial infarction • No mortality • Protocol implementation to all surgical services is expected to favorably impact the results

  9. Next Steps • Ongoing education to improve visibility of the protocol • Identify potential for EPIC prompts • Ongoing comparison with UHC hospitals • Expand project to hospitalized patients undergoing non-elective surgeries

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