Friday, October 14, 2011

Care redesign teams begin implementing quality recommendations

As part of the Partnerswide Strategic Initiative, teams of experts from the MGH and other Partners affiliates are focusing on ways to improve the quality and efficiency of care. The effort began with five multidisciplinary case redesign teams developing recommendations for specific diseases and procedures. This first round of teams began implementing the recommendations Oct. 1 and will be measuring their effectiveness. Teams will report these findings to Partners leadership and use them to further refine the recommendations. MGH Hotline is publishing a series highlighting the efforts of several of these teams.

Coronary artery bypass graft (CABG) surgery, the most common open-heart procedure in the United States, is used to treat patients with coronary artery disease, which can lead to serious complications such as heart attacks. During a CABG procedure, a healthy artery or vein is grafted to a blocked coronary artery in order to bypass the block and maintain normal blood flow to the heart. In addition to being a high-volume operation, CABG surgery represents a substantial use of hospital resources, and as such, is quite costly.

Over the last year, a team of caregivers, administrators, data analysts and other experts led by cardiac surgeon Arvind Agnihotri, MD – director of Cardiac Surgery Quality Improvement and of Less Invasive and Robotic Heart Surgery – has collaborated to identify opportunities to make CABG more efficient, creating the best possible outcomes for patients and potentially reducing overall costs. Their recommendations build upon CABG quality improvement and measurement efforts that have taken place across Partners hospitals for more than a decade and are based on the latest research and data from national organizations. The team’s initial recommendations, which were reviewed and approved by MGH and Partners leadership, are:

  • Provide patients with a nurse care navigator who will offer guidance and support throughout the entire episode of care;
  • Reduce blood product utilization by decreasing the amount of products used per patient and the number of pients that require blood products;
  • Admit patients on the day of surgery unless earlier admission is medically necessary;
  • Standardize resources used in the operating room based on best practice guidelines and cost efficiency;
  • Reduce length-of-stay by standardizing care practices in intensive care and intermediate care settings; and
  • Follow standard protocol for anticoagulation management for cardiopulmonary bypass and postoperative care.

The team already implemented same-day admission for most patients, and a subgroup currently is addressing opportunities for reducing blood product utilization before, during and after CABG surgeries.

“Reducing blood product utilization is one of the recommendations we are most excited to implement,” says Agnihotri. “Reducing blood product utilization benefits everyone involved. It’s better for the patient to avoid transfusions because of the associated complications, and reducing transfusions significantly reduces costs because blood products are very expensive.”

Adds Mike Andrawes, MD, of the Department of Anesthesia, Critical Care and Pain Medicine, “By ensuring that we use blood products as efficiently as possible – that we don’t give unnecessary transfusions or order blood products preemptively and end up having them go to waste – we can improve the quality of care and make it more affordable.”

Andrawes and his colleague Greg Koski, MD, are leading the effort for Cardiac Anesthesia in this multidisciplinary subgroup, which also involves members of the Cardiac Intensive Care Unit (ICU), including William Hoffman, MD; the Blood Transfusion Service, including Sunny Dzik, MD; Cardiac Perfusion; ICU Nursing; and Cardiac Surgery physician assistants.

Read more about the Strategic Initiative and the efforts of all the care redesign teams.

Read more articles from the 10/14/11 Hotline issue.

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