Recently I attended the 2017 Annual Meeting of The American Academy of Cardiovascular Perfusion. The AACP, as always, offered strong educational content and a great opportunity to meet up with friends and colleagues. While there, I had the pleasure of presenting co-authored research on “The Effectiveness of Acute Normovolemic Hemodilution and Autologous Prime on Intraoperative Blood Management during Cardiac Surgery.” The AACP honored our team, which includes our perfusion associates and their tireless dedication to clinical excellence and data collection, by selecting this work as the meeting’s Best Paper. I encourage you to read the abstract for additional detail, but here’s a summary of our findings, which highlight the value of thoughtful perfusion strategies that can reduce the need for costly transfusions and increase the likelihood of better clinical outcomes.
Changes in reimbursement models are driving changes in operations, including data collection and reporting. Providers are being encouraged and incentivized to implement value-based care (VBC) that emphasizes cost savings and quality outcomes instead of the traditional fee-for-service (FFS) reimbursement model that pays according to the number of procedures performed. The idea is that when hospitals have financial incentives to be accountable for patient outcomes, then the comprehensive focus on quality will result in overall lower costs. Transitioning from FFS to VBC may be especially difficult for ORs with their high costs of procedures, but several strategies can help clear the path to progress.
Ultrafiltration is thought to reduce morbidity and the risk of red blood cell transfusion, however very few studies have examined the relationship between ultrafiltration and the overall risk of intraoperative RBC transfusion. Using data from the SpecialtyCare Operative Procedural Registry (SCOPE™), our study looks at a population of nearly 98,000 adults undergoing cardiac surgery at 197 hospitals to evaluate the effects of ultrafiltration volume removed during CPB on the relative risk of receiving an intraoperative RBC transfusion. Recognizing the findings of our own previous work, we were especially interested in testing potential differences between male and female patients in the effects of ultrafiltration.
The mission of The Joint Commission (TJC) is “to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.” It’s a lofty goal, and one that has helped thousands of healthcare organizations improve. Unfortunately, the prospect of a TJC review is stressful and overwhelming for many healthcare providers. It doesn’t have to be. Check out these three things we’ve learned by designing and implementing a tested program that ensures that the people of our organization are always prepared to pass a stringent TJC evaluation while also meeting the requirements of our own internal quality programs.
It is a fairly well-known fact in the cardiac community that women have higher morbidity and mortality associated with coronary artery bypass (CABG) procedures. The reasons traditionally given for this disparity include women’s relatively smaller vasculature, higher incidence of anemia, and smaller circulating blood volume. Early in 2016, we in the Medical Department were discussing this phenomenon and decided to design a study using the robust data from our SpecialtyCare Operative Procedural Registry to find something in the intraoperative space that might be leading to these very different post-operative outcomes for men and women. Our findings were somewhat surprising.
The role of an expert IONM team is critical in the timely identification of adverse neurophysiologic changes and in promoting corrective action by the surgeon and anesthesiologist. Our research is based on clinical IONM data from SpecialtyCare’s Operative Procedural Registry. Taking advantage of big data—nearly 70,000 cases in this study—ensures that our conclusions are statistically significant, a vital aspect of evidence-based improvement in healthcare. It was an honor to present this study to such a prestigious group of surgeons at NASS and, in doing so, provide actionable information to help elevate the quality of care across the country.
It’s not surprising that surgeons report high levels of burnout and a lack of professional satisfaction; nor is it surprising that the problem is getting worse. This creates concern for both the well-being of surgeons and the quality of patient care. As with other problems that might seem overwhelming, however, small adjustments can make a big difference. Here are some ways you can move the needle on surgeon satisfaction and, by extension, create efficiencies, lower costs, and realize better patient outcomes.
Our intraoperative neuromonitoring (IONM) research studies show that IONM helps keep patients safe during surgery, decreases complications, and reduces costs associated with the use of analgesics, length of hospital stay, neurorehabilitation, and long-term chronic care. One such study, Neurologic Outcomes Following Differential Resolution of Neuromonitoring Alerts during Extradural Spine Surgery, examines the relationship between reversal of intraoperative neurophysiologic change and neurologic outcome following segmental spine surgery.
The source of nosocomial infections can be elusive. For investigators, infections stemming from slow-growing bacteria are particularly difficult to identify and combat when symptoms do not present for months, or sometimes even years, after exposure. Add to these challenges the severity of potentially deadly infections and a bacterial outbreak can have devastating consequences. Such is the case with nontuberculous mycobacteria (NTM).
Excellence in sterile processing management is fundamental to a well-run operating room. It supports on-time starts, surgeon satisfaction, and overall efficiency—all of which translate to financial results. But, most importantly, effective sterile processing management reduces the occurrence of healthcare-acquired infections (HAIs), which can significantly harm the patients entrusted to your care.