• J. Cardiothorac. Vasc. Anesth. · Jun 2014

    Observational Study

    Implementing Goal-directed Protocols Reduces Length of Stay After Cardiac Surgery.

    • Anne Miller, Chad E Wagner, Yanna Song, Kathleen Burns, Rashid Ahmad, C Lee Parmley, and Matthew B Weinger.
    • Departments of Anesthesiology and Critical Care.
    • J. Cardiothorac. Vasc. Anesth.. 2014 Jun 1;28(3):441-7.

    ObjectiveTo test the effect of a high reliability organization (HRO) intervention on patient lengths of stay in the CVICU and hospital. The authors proposed that (1) higher safety related evidence based protocol (SREBP) team compliance scores and (2) lower SREBP milestone scores are associated with shorter lengths of CVICU and hospital stay.DesignA prospective, longitudinal observational evaluation was used to assess the effects of SREBP-focused rounding processes and a milestone-tracking tool.SettingUnited States, university academic medical center's 27-bed CVICU.ParticipantsSix hundred sixty-five adult cardiac surgery patients and the CVICU care team (100 registered nurses and 16 clinical providers) participated.Measurements And Main ResultsTeam compliance was the proportion of SREBP-related team behaviors exhibited during daily rounds. Patients' milestone scores were the cumulative difference between actual and expected times for 4 SREBP milestones over 48 hours. Milestones achieved earlier than expected indicated reduced complication risk, and milestones achieved later than expected indicated increased risk. As team compliance increased, CVICU length of stay decreased 0.66 (95% CI: -0.04 to 1.28; p = 0.08) days; hospital stay decreased 0.89 times (95% CI: 0.77-1.03; p = 0.008). As the mean milestone scores increased from -7 to 12, length of ICU stay increased 2.63 (95% CI: 1.66-3.59; p<0.001) days; hospital length of stay increased 1.44 times (95% CI: 1.23-1.7; p = 0.05).ConclusionsA milestone-driven pathway supported by team rounding was associated with decreased lengths of CVICU and hospital stay. However, tracking patient trajectories by milestones suggests a more complex relationship than anticipated and presents new opportunities for SREBP implementation and research.Published by Elsevier Inc.

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