Friday, March 15, 2013

Communication is key for cardiac surgery team

As part of the Partners Strategic Initiative, teams of experts from the MGH and other Partners affiliates are focusing on ways to improve the quality anzqd efficiency of care. Since 2010, 15 multidisciplinary care redesign teams have been formed at the MGH to develop and implement recommendations for specific diseases and procedures. This is the latest of a continuing series of MGH Hotline articles highlighting the efforts of several of these teams. Communication is key for cardiac surgery team

This May marks the 60th anniversary of the first successful open-heart surgery performed by John Gibbon, MD, using cardiopulmonary bypass (CPB), also known as the heart-lung machine. Gibbon conceived of the idea for the machine while serving as a research fellow at the MGH in the early 1930s. Since that time, all complex cardiac surgery for both acquired and congenital heart disease has become common – with excellent results. Here at the MGH, more than 1,200 of these surgeries are performed on an annual basis.

However, despite its popularity and success in treating patients with heart disease, staff within MGH cardiac surgery knew there were still ways they could make improvements in their practice. Late last year, the Coronary Artery Bypass Graft Care Redesign team – made up of anesthesiologists, perfusionists and surgeons – formed a subgroup focused specifically on the practice of CPB. They began to investigate different ways they could strengthen not only how care was administered, but also how they could work more collaboratively on a daily basis.

“Our prime directive was the safety of our patients,” says Thomas MacGillivray, MD, co-director of the Thoracic Aortic Center and surgical director of Mechanical Circulatory Support. “This project really was about the approach to care, rather than the care itself. We looked at this project as a way to try to make the process more uniform – mapping out best practices that would benefit all, and then making those the standard of care. We began to outline how we could promote better communication in the operation of CPB.”

The end result is a thorough communication plan and a streamlined checklist for all staff to follow before, during and after each cardiac bypass procedure. “This was a key process where perfusionists drafted a series of guidelines to provide a framework for how each CPB procedure should look, how concerns and questions will be addressed and what the expectations are of the team,” says Kenneth Shann, director of Perfusion Services. “While every patient’s surgery and care plan is still managed independently, these guidelines provide a better way for everyone in the room to communicate.”

With a continued focus on strengthening communication, the team also recently implemented an interdisciplinary preoperative briefing for each surgical patient. The new process includes an outline to guide discussion regarding each aspect of the surgical, anesthesia and perfusion procedures. “The purpose of the briefing is to develop a patient-specific care plan by facilitating an effective exchange of information between all members of the operative team,” Shann says. “We expect this communication will minimize interruptions in workflow and enhance the safety and quality of care.”

While the new care redesign implementations are still in their early stages, staff agree they have already seen positive changes, including a greater sense of connection between colleagues. “What makes the MGH great is that we take unusual problems and treat them in a unique way,” MacGillivray says. “The team was very driven from the start of this project and we had the mindset that this was going to have us go from great to greater in making the system stronger. Everybody here is a professional whose training and experience is essential to the management of our patients. This process has only strengthened our team. We can proudly say that we provide the best care anywhere for patients who need heart surgery.”

Read more articles from the 03/15/13 Hotline issue.

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