1. STRATEGIES TO IMPROVE CARDIAC SURGERY OUTCOMES
Ganga Prabhakar, M.D. Iowa Heart Center, Mercy Medical Center, Iowa

2. Disclosures Edwards Lifesciences Evalve, Inc. Medtronic
Employee-Iowa Heart Center/Mercy-Des Moines

3. PATIENT CENTERED Improving outcomes not always easy
Concerted concentrated effort on multiple fronts
Constant vigilance once a parameter improves
Large team effort (data collectors/analysts, nurses,pharmacists,rehab,SW,palliative,MLP,MD
Pre-op to post operative care in and outside hospital

4. VALUE SHIFT SHIFT FROM SUPPLY DRIVEN TO PATIENT CENTERED
SHIFT FROM VOLUME AND PROFITABILITY TO PATIENT OUTCOME

5. VALUE AGENDA

6. SYSTEM ENGINEERING INITIATIVE TO PATIENT SAFETY (SEIPS)

7. PRE SURGICAL PREOP EDUCATION PREOP ANESTHESIA VISIT
Realistic expectation
Anticipated course
Palliative consult prn
PREOP ANESTHESIA VISIT
Pain
Nausea
Intubation
Anecdotal evidence refutation

8. PRESURGICAL PREOP TESTING CAROTIDS PFT
LABS INCLUDING NUTRITIONAL STATUS
FRAILTY EVALUATION

9. Preop PFT’s and Cardiac Surgery
PFT’s before cardiac surgery reclassifies the COPD status.
Provides important prognostic information that would not be otherwise captured.
Pulmonologist for optimization

10. SURGICAL HUDDLES PREOP HUDDLES POSTOP ENVIRONMENT TEAM EFFORT
FREEDOM TO SPEAK
TRAINING
HEATER COOLERS OUTSIDE ROOM

12. SURGICAL SURGICAL TECHNIQUES STAYING UPDATED
VEIN HARVEST OPEN OR ENDOSCOPIC
MICS

13. Post Cardiac Surgery Sedation
Delirium was 3% with Dexmedetomidine
Delirium was 50% with Propofol
Delirium was 50% with midazolam.
Delirium is associated with increased LOS and LOH
TYLENOL IV/PO

14. POST SURGICAL EARLY EXTUBATION Process starts in OR
Involves awareness from nurses/RT
Success failure continuum

17. POST SURGICAL BLOOD CONSERVATION EARLY RETURN TO OR FOR BLEEDING
MINIMIZE TRANSFUSION
LOWER THRESHOLD
IS 7 THE NEW 8!

19. Blood Transfusion and Infection in Cardiac Surgery

20. Confusion and Cardiac Surgery
4 variables independently associated with delirium:
prior stroke or transient ischemic attack,
Mini Mental State Examination score,
abnormal serum albumin,
the Geriatric Depression Scale

21. POST SURGICAL
VTE PROPHYLAXIS
EARLY

22. POST SURGICAL EARLY MOBILITY REPEATED MOBILITY
NURSE DRIVEN MOBILITY PROTOCOL
NOK INVOLVEMENT

25. EXTENDED SURGICAL CARE
DISCHARGE PHONE CALL
ONE WEEK APPT
HOME WITH MEDICATION SUPPLY

28. EXTENDED SURGICAL CARE
HOME MOBILITY EXPECTATION
CARDIAC REHAB EXPECTATION

29. EXTENDED SURGICAL CARE
READMISSION REDUCTION
EFFUSIONS
ATRIAL FIBRILLATIONS
PNEUMONIA

30. PROTOCOL DRIVEN SHARED BEST PRACTICES SITE EXCHANGE VISITS
BUNDLED PAYMENTS CHI
Administration/clinician bridging
Combine all payments

33. GLOBAL CONSORTIA
INTERNATIONAL CONSORTOUM OF HEALH OUTCOMES MEASUREMENT (ICHOM)
TIME DRIVEN ACTIVITY-BASED COSTING (TDABC)

34. PUBLIC REPORTING
Consumer Reports Ranks Bypass Surgery Centers