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Carotid artery endarterectomy: a multidisciplinary approach to improving resource utilization and quality assurance
Jill A Knutson1, Carol Jo Morse, Jens Eldrup-Jorgensen
1Maine Medical Center, Portland, Maine 04101, USA. Knutsj@mmc.org
Insights
Carotid endarterectomy (CEA) care was redesigned to improve cost-effectiveness. Streamlining patient flow to non-telemetry beds reduced costs without impacting patient outcomes, benefiting stroke prevention efforts.
Area of Science:
- Vascular Surgery
- Healthcare Management
- Quality Improvement
Background:
- Stroke remains a significant public health concern, with approximately 780,000 cases annually in the US.
- Carotid endarterectomy (CEA) is a primary surgical intervention for stroke prevention.
- Healthcare providers face pressure to deliver CEA cost-effectively while maintaining high clinical standards.
Purpose of the Study:
- To evaluate the impact of a redesigned care pathway for Carotid Endarterectomy (CEA) patients.
- To assess the feasibility and outcomes of admitting select CEA patients to non-telemetry surgical beds.
- To determine if practice changes improve cost-efficiency without compromising patient safety and outcomes.
Main Methods:
- Implementation of a critical pathway, computerized order set, and standardized patient education materials.
- Introduction of a patient flow algorithm to bypass intermediate care units for eligible CEA patients.
- Analysis of 467 chart audits from 2010-2011 using the Vascular Study Group of New England data collection form.
Main Results:
- The redesigned care pathway and direct admission to non-telemetry units were successfully implemented.
- Significant cost savings were achieved through the revised patient management strategy.
- No negative impact on patient outcomes was observed following the implementation of these changes.
Conclusions:
- Redesigning Carotid Endarterectomy (CEA) care pathways can lead to substantial cost savings.
- Direct admission of select CEA patients to non-telemetry beds is safe and effective.
- These practice changes enhance the availability of critical care resources for higher-acuity patients.
Abstract:
An estimated 780,000 people in the United States have a stroke each year. Carotid endarterectomy (CEA) is the most frequently performed surgical procedure to prevent the occurrence of stroke. Over the past several years, physicians, nurses, and allied healthcare workers have been challenged to perform this operation in a cost-effective manner without compromising clinical outcomes. At Maine Medical Center (MMC), Portland, Maine, an average of 250 CEAs are performed annually. As part of a quality-assurance initiative, MMC key stakeholders redesigned the care of patients undergoing CEA surgery. A critical pathway supported by a computerized order set was implemented; standardized discharge instructions and a patient teaching brochure were developed. A patient flow algorithm allowing select patients to bypass the intermediate care unit and transfer directly from the post-anesthesia care unit to a non-telemetry surgical bed was instituted. From January 1, 2010, to December 31, 2011, 467 chart audits were completed on 100% of CEA surgeries (cases with concomitant procedures excluded) using the Vascular Study Group of New England data collection form. Data analyzed supports the practice changes that were instituted. Allowing patients to be admitted to a non-telemetry surgical unit following CEA has resulted in significant cost savings and increased the availability of intermediate care beds to higher acuity patients without negatively affecting patient outcomes.
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