Process improvement in cardiac surgery: Development and implementation of a reoperation for bleeding checklist

Loor, Gabriel; Vivacqua, Alessandro; Sabik, Joseph F.; Li, Liang; Hixson, Eric D.; Blackstone, Eugene H.; Koch, Colleen G.

doi:10.1016/j.jtcvs.2013.05.043

Cited by 44 publications

(42 citation statements)

References 28 publications

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“…The number of operations per year came from a workforce survey of 1211 surgeons performed by the Society of Thoracic Surgeons . We predicted a 2.0% to 1.5% rate of decreased operative complications for BRC and RFB, respectively, as a result of the educational intervention based on the incidence of these complications . In the OIA base case, we modeled 3 in 10 participants implementing learning to prevent a BRC or RFB.…”

Section: Methodsmentioning

confidence: 99%

Estimating Health Care Cost Savings from an Educational Intervention to Prevent Bleeding-Related Complications: The Outcomes Impact Analysis Model

Ravyn

Lowney

et al. 2014

Journal of Continuing Education in the Health Professions

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Section: Methodsmentioning

confidence: 99%

Estimating Health Care Cost Savings from an Educational Intervention to Prevent Bleeding-Related Complications: The Outcomes Impact Analysis Model

Ravyn

Lowney

et al. 2014

Journal of Continuing Education in the Health Professions

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“…Foremost among these are investigations of blood product use [12, 13]. We studied the effect of transfusion and reoperation for bleeding on outcomes [12, 13] and developed and implemented a reoperation for bleeding checklist that resulted in a reduction in reoperations for bleeding [14]. We evaluated the frequency of laboratory testing in patients undergoing cardiac operations and proposed strategies to reduce phlebotomy volumes for preventing hospital-acquired anemia [15].…”

Section: Commentmentioning

confidence: 99%

Enhancing the Value of Population-Based Risk Scores for Institutional-Level Use

Raza

Sabik

Rajeswaran

et al. 2016

The Annals of Thoracic Surgery

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Background We hypothesized that factors associated with an institution’s residual risk unaccounted for by population-based models may be identifiable and used to enhance the value of population-based risk scores for quality improvement. Methods From January 2000 to January 2010, 4,971 patients underwent aortic valve replacement (AVR), either isolated (n= 2,660) or with concomitant coronary artery bypass grafting (AVR+CABG; n = 2,311). Operative mortality and major morbidity and mortality predicted by The Society of Thoracic Surgeons (STS) risk models were compared with observed values. After adjusting for patients’ STS score, additional and refined risk factors were sought to explain residual risk. Differences between STS model coefficients (risk-factor strength) and those specific to our institution were calculated. Results Observed operative mortality was less than predicted for AVR (1.6% [42 of 2,660] vs 2.8%, p < 0.0001) and AVR+CABG (2.6% [59 of 2,311] vs 4.9%, p < 0.0001). Observed major morbidity and mortality was also lower than predicted for isolated AVR (14.6% [389 of 2,660] vs 17.5%, p < 0.0001) and AVR+CABG (20.0% [462 of 2,311] vs 25.8%, p < 0.0001). Shorter height, higher bilirubin, and lower albumin were identified as additional institution-specific risk factors, and body surface area, creatinine, glomerular filtration rate, blood urea nitrogen, and heart failure across all levels of functional class were identified as refined risk-factor variables associated with residual risk. In many instances, risk-factor strength differed substantially from that of STS models. Conclusions Scores derived from population-based models can be enhanced for institutional level use by adjusting for institution-specific additional and refined risk factors. Identifying these and measuring differences in institution-specific versus population-based risk-factor strength can identify areas to target for quality improvement initiatives.

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“…There was a 1.8-fold increased risk of composite outcome (adjusted rate 3.33%, 95% CI 3.09-3.58%) in patients managed by low-performance anaesthesiologists compared with high-performance anaesthesiologists (adjusted rate 1.82%, 95% CI 1.58-2.10%) [49 && ]. Furthermore, a study by Loor et al demonstrated that implementing an intra-operative checklist in collaboration between anaesthesiologist and surgeon minimizes postoperative bleeding due to technical reasons, and leads to significantly less need for re-exploration [50]. Making use of this information, CABG outcomes may further improve with team (surgeons and anaesthesiologists) initiatives, such as Flawless Operative Cardiovascular Unified Systems (FOCUS), to decrease mortality [51].…”

Section: Refinements In Anaesthesiamentioning

confidence: 99%