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Making Surgery Safer: Preventing Postoperative Myocardial ...

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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 0.000 0.002 0.004 0.006 0.008 0.010 0.012 0.014 0.016 0.018 Q1 1999 Q2 1999 Q3 1999 Q4 1999 Q1 2000 Q2 2000 Q3 2000 Q4 2000 Q1 2001 Q2 2001 Q3 2001 Q4 2001 Q1 2002 Q2 2002 Q3 2002 Q4 2002 Q1 2003 Q2 2003 Q3 2003 Q4 2003 Q1 2004 Q2 2004 Q3 2004 UHC Population Mean Loyola Mean Project Started 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