The 30-Year Influence of a Regional Consortium on Quality Improvement in Cardiac Surgery

Iribarne, Alexander; Leavitt, Bruce J.; Westbrook, Benjamin M.; Quinn, Reed D.; Klemperer, John D.; Sardella, Gerald L.; Kramer, Robert S.; Charlesworth, D.; Morton, Jeremy R.; Marrin, Charles A.S.; DiScipio, Anthony W.; McCullough, Jock N.; Ross, Cathy S.; Malenka, David J.

doi:10.1016/j.athoracsur.2019.10.008

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…As the concept of phase-of-care mortality analysis is more often used to determine root cause of death, and as use of the occurrence of failure-to-rescue becomes increasingly recognized as a quality metric of cardiac surgical programs, it is notable that programs with lower operative mortality are associated with higher ability to rescue patients from complications. 29 , 30 Furthermore, recent data suggest that the use of a dedicated 24/7 cardiac ICU care team 31 and quality improvement initiatives 32 may result in incremental improvement in outcomes over time. It is apparent, however, based on the data collected in this survey along with the available CIHI data, that there is no clear consensus regarding the ideal CVICU structure or staffing model.…”

Section: Discussionmentioning

confidence: 99%

Characterizing Physician-Staffing Models in the Care of Postoperative Cardiac Surgical Patients in Canada

et al. 2021

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Background Current intensive care unit physician-staffing (IPS) models for postoperative cardiac surgery have not been previously investigated in Canada. The purpose of this study was to determine current IPS models at 2 time points and describe the evolution of Canadian cardiac surgery IPS models. Methods A survey of 32 Canadian cardiovascular intensive care units (CVICUs) was undertaken in 2012 and 2017 to determine IPS models of care during “daytime” and “after-hours” in each unit. Data were collected regarding surgical volume, base specialties, and style of IPS management (“open”; “semi-open”; “closed”). In addition, we collected the overnight experience level of the bedside healthcare provider for in-house intensive care units. Results Survey responses were received from 27 of 32 CVICUs (87%). As of 2017, the style of 1 (4%) was open, 7 (26%) were semi-open, and 19 (70%) were closed in their unit IPS strategy. Base specialties of CVICU physicians varied. A medical doctor provided after-hours coverage in 81% of CVICUs. Senior residents (37%) or critical care certified attending staff (25%) typically provided after-hours coverage for in-house CVICUs. Linked Canadian Institute for Health Information data did not indicate a difference among CVICU models in mortality or rehospitalization for coronary artery bypass graft or valve procedures. Conclusions Considerable heterogeneity is demonstrated in CVICU staffing patterns. No consensus was identified regarding the appropriate level of training for “after-hours” coverage. In-house overnight physician staffing in CVICUs varies widely. Finally, semi-open and closed style models did not demonstrate differences compared to Canadian Institute for Health Information data. Variability among CVICUs does exist; however, benefits of one model over another have not been identified.

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Section: Discussionmentioning

confidence: 99%

Characterizing Physician-Staffing Models in the Care of Postoperative Cardiac Surgical Patients in Canada

et al. 2021

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“…It recently published data on quality outcomes over this time period. 23 The unadjusted inhospital mortality rates were reduced from 3.4% in the earliest time to 1.8% currently (P < .001). In addition, the authors reported continuous reductions in rates of prolonged intubations > 24 hours/reintubation, acute kidney injury, mediastinitis, reoperations for bleeding, and low output heart failure.…”

Section: Participation In Regional Quality Initiativesmentioning

confidence: 91%

Role of Value-Added Care by Cardiothoracic Anesthesiology and Impact on Outcomes After Cardiac Surgery

Ariyo

Abernathy

Hensley

2022

Semin Cardiothorac Vasc Anesth

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The medical community is increasingly aware of the need for high-quality and high-value patient care. Anesthesiologists in particular have long demonstrated leadership in the field of quality and safety. Cardiothoracic anesthesiologists can improve the quality of care delivered to cardiac patients both with anesthesia-specific practices and in a team-based approach with other perioperative care providers. Collecting large volumes of multicentered data to study, measure, and improve anesthesia care is one of the many commitments of cardiothoracic anesthesiologists to this cause. This article reviews this and other aspects of the work of cardiothoracic anesthesiologists to improve value-added care to cardiac patients.

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“…There have been some advances in specific areas, most prominently in healthcare-acquired infections, 5 led by reductions in catheter-related bloodstream infections. 6,7 It has been possible to reduce deaths related to cardiac surgery, 8 and general surgery 9 using quality improvement strategies and the World Health Organization (WHO) safe surgery checklist. 10 Although there have been others, they are more difficult to measure.…”

mentioning

confidence: 99%

Getting better: Staying ahead of the curve on patient safety

2023

Journal of Patient Safety and Risk Management

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The 30-Year Influence of a Regional Consortium on Quality Improvement in Cardiac Surgery

Cited by 8 publications

References 26 publications

Characterizing Physician-Staffing Models in the Care of Postoperative Cardiac Surgical Patients in Canada

Characterizing Physician-Staffing Models in the Care of Postoperative Cardiac Surgical Patients in Canada

Role of Value-Added Care by Cardiothoracic Anesthesiology and Impact on Outcomes After Cardiac Surgery

Getting better: Staying ahead of the curve on patient safety

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