Standardized practice design with electronic support mechanisms for surgical process improvement

reducing mechanical ventilation time

David J. Cook, Juan N. Pulido, Jeffrey E. Thompson, Joseph A. Dearani, Matthew J. Ritter, Andrew C. Hanson, Bijan J Borah, Elizabeth B Habermann

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND: Hospital surgical care is complex and subject to unwarranted variation.

OBJECTIVE: As part of a multiyear effort, we sought to reduce variability in intraoperative care and management of mechanical ventilation in cardiac surgery. We identified a patient population whose care could be standardized and implemented a protocol-based practice model reinforced by electronic mechanisms.

METHODS: In a large cardiac surgery practice, we built a standardized practice model between 2009 and 2011. We compared mechanical ventilation time before (2008) and after (2012) implementation. To ensure groups were comparable, propensity analysis matched patients from the 2 operative years.

RESULTS: In 2012, more than 50% of all cardiac surgical patients were managed with our standardized care model; of those, 769 were one-to-one matched with patients undergoing surgery in 2008. Patients had a mix of coronary artery bypass grafting, valve surgery, and combined procedures. Our practice model reduced median mechanical ventilation duration from 9.3 to 6.3 hours (2008 and 2012) (P < 0.001) and intensive care unit length of stay from 26.3 to 22.5 hours (P < 0.001). Reintubation and intensive care unit readmission were unchanged. Variability in ventilation time was also reduced.

CONCLUSIONS: We demonstrate that in more than 50% of all cardiac surgical patients, a standardized practice model can be used to achieve better results. Clinical outcomes are improved and unwarranted variability is reduced. Success is driven by clear patient identification and well-defined protocols that are clearly communicated both by electronic tools and by empowerment of bedside providers to advance care when clinical criteria are met.

Original languageEnglish (US)
Pages (from-to)1011-1015
Number of pages5
JournalAnnals of Surgery
Volume260
Issue number6
DOIs
StatePublished - Dec 1 2014

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Artificial Respiration
Thoracic Surgery
Intensive Care Units
Intraoperative Care
Coronary Artery Bypass
Ventilation
Length of Stay
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Standardized practice design with electronic support mechanisms for surgical process improvement : reducing mechanical ventilation time. / Cook, David J.; Pulido, Juan N.; Thompson, Jeffrey E.; Dearani, Joseph A.; Ritter, Matthew J.; Hanson, Andrew C.; Borah, Bijan J; Habermann, Elizabeth B.

In: Annals of Surgery, Vol. 260, No. 6, 01.12.2014, p. 1011-1015.

Research output: Contribution to journalArticle

Cook, David J. ; Pulido, Juan N. ; Thompson, Jeffrey E. ; Dearani, Joseph A. ; Ritter, Matthew J. ; Hanson, Andrew C. ; Borah, Bijan J ; Habermann, Elizabeth B. / Standardized practice design with electronic support mechanisms for surgical process improvement : reducing mechanical ventilation time. In: Annals of Surgery. 2014 ; Vol. 260, No. 6. pp. 1011-1015.
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abstract = "BACKGROUND: Hospital surgical care is complex and subject to unwarranted variation.OBJECTIVE: As part of a multiyear effort, we sought to reduce variability in intraoperative care and management of mechanical ventilation in cardiac surgery. We identified a patient population whose care could be standardized and implemented a protocol-based practice model reinforced by electronic mechanisms.METHODS: In a large cardiac surgery practice, we built a standardized practice model between 2009 and 2011. We compared mechanical ventilation time before (2008) and after (2012) implementation. To ensure groups were comparable, propensity analysis matched patients from the 2 operative years.RESULTS: In 2012, more than 50{\%} of all cardiac surgical patients were managed with our standardized care model; of those, 769 were one-to-one matched with patients undergoing surgery in 2008. Patients had a mix of coronary artery bypass grafting, valve surgery, and combined procedures. Our practice model reduced median mechanical ventilation duration from 9.3 to 6.3 hours (2008 and 2012) (P < 0.001) and intensive care unit length of stay from 26.3 to 22.5 hours (P < 0.001). Reintubation and intensive care unit readmission were unchanged. Variability in ventilation time was also reduced.CONCLUSIONS: We demonstrate that in more than 50{\%} of all cardiac surgical patients, a standardized practice model can be used to achieve better results. Clinical outcomes are improved and unwarranted variability is reduced. Success is driven by clear patient identification and well-defined protocols that are clearly communicated both by electronic tools and by empowerment of bedside providers to advance care when clinical criteria are met.",
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