Standardized practice design with electronic support mechanisms for surgical process improvement: reducing mechanical ventilation time

Hospital surgical care is complex and subject to unwarranted variation. 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 implement...

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Bibliographic Details
Published in:Annals of surgery Vol. 260; no. 6; p. 1011
Main Authors: Cook, David J, Pulido, Juan N, Thompson, Jeffrey E, Dearani, Joseph A, Ritter, Matthew J, Hanson, Andrew C, Borah, Bijan J, Habermann, Elizabeth B
Format: Journal Article
Language:English
Published: United States 01.12.2014
Subjects:
Aged
Automatic Data Processing - methods
Cardiac Surgical Procedures
Female
Follow-Up Studies
Humans
Intensive Care Units
Intraoperative Care - standards
Intubation, Intratracheal
Male
Practice Guidelines as Topic
Respiration, Artificial - methods
Retrospective Studies
Treatment Outcome
ISSN:1528-1140, 1528-1140
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Summary:Hospital surgical care is complex and subject to unwarranted variation. 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. 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. 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. 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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ISSN:1528-1140
1528-1140
DOI:10.1097/SLA.0000000000000726