1. Jennifer Bobbitt RN BSN, MCSQI Collaborative, and Clifford Fonner BA
The Maryland Cardiac Surgery Quality Initiative:
Collaborating to Improve Outcomes Statewide
Diane Alejo BA, Keith Horvath MD, Rawn Salenger MD, John Conte MD, Glenn Whitman MD,
Jennifer Bobbitt RN BSN, MCSQI Collaborative, and Clifford Fonner BA
Background
Founded in 2013, the Maryland Cardiac Surgery Quality Initiative (MCSQI) is an inclusive, non-profit statewide consortium of all 10 cardiac programs in the state. MCSQI fosters collaboration between all stakeholders delivering cardiac surgery. Uniquely, the consortium has aligned with the Maryland Health Care Commission (MHCC) to improve oversight and ensure best practices to favorably impact patient outcomes. With its collaborative approach, MCSQI has provided a voice to inform and impact state health policy. Surgeon participation and Society of Thoracic Surgeons (STS) data manager engagement has been the key to its success.
Results
High and low performers were identified for early extubation (CAB: 15% – 83%; AVR: 17% – 77%) and transfusion of any blood product (CAB: 38% – 80%; AVR: 45% – 85%), with some variation among sites. High performers have shared their protocols and quality improvement efforts are ongoing.
Methods
MCSQI has adopted the STS database as the foundation for outcomes analysis and process improvement. Collaboration between surgeons, data managers, and administrative leadership plays an integral role in promoting outcome reporting and adopting evidence-based best practices. We conducted a focused review of 75 STS fields, with blood conservation and reduction of ventilation times as the initial targeted quality improvement initiatives aimed at improving protocols statewide.
Conclusion
MCSQI brought together the cardiac surgery teams in Maryland and provided recommendations on drafted legislation reflecting opinions of cardiac surgeons, database managers, and hospital administrators on new state-mandated regulations. Although MCSQI is a young organization, aligning goals and comparing site protocols will serve to improve the quality and safety of cardiac surgical care for all patients in Maryland.
Timeline of Milestones: “Working together to improve the quality of cardiac surgery in the state of Maryland”
Disclosures: John Conte, MD (Research Grants: Medtronic, Boston Scientific Corporation,
and St. Jude Medical; Advisory Board role: Sorin Group and Medtronic)