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Implementing goal-directed protocols reduces length of stay after cardiac surgery

Anne Miller1, Chad E Wagner1, Yanna Song2

  • 1Departments of Anesthesiology and Critical Care.

Journal of Cardiothoracic and Vascular Anesthesia
|April 22, 2014
PubMed

Insights

Implementing a high reliability organization (HRO) intervention, focusing on safety related evidence based protocols (SREBP) and milestone tracking, reduced patient lengths of stay in the CVICU and hospital.

Area of Science:

  • Healthcare quality improvement
  • Patient safety research
  • Cardiac surgery intensive care

Background:

  • High Reliability Organization (HRO) interventions aim to enhance patient safety and operational efficiency.
  • Safety Related Evidence Based Protocols (SREBP) are crucial for standardizing care and improving outcomes.
  • Understanding the impact of HRO interventions on patient length of stay is vital for resource management and quality assessment.

Purpose of the Study:

  • To evaluate the effect of a high reliability organization (HRO) intervention on patient lengths of stay in the Cardiac Vascular Intensive Care Unit (CVICU) and hospital.
  • To determine the association between safety related evidence based protocol (SREBP) team compliance scores and patient length of stay.
  • To investigate the relationship between SREBP milestone scores and patient length of stay.

Main Methods:

  • A prospective, longitudinal observational study design was employed.
  • The intervention involved SREBP-focused rounding processes and a milestone-tracking tool.
  • Data were collected from 665 adult cardiac surgery patients and their CVICU care team at a US academic medical center.

Main Results:

  • Increased team compliance with SREBP protocols was associated with a trend towards decreased CVICU length of stay (0.66 days) and a significant decrease in hospital stay (0.89 times).
  • Higher mean milestone scores (indicating earlier achievement of SREBP milestones) were significantly associated with increased CVICU length of stay (2.63 days) and hospital length of stay (1.44 times).
  • The findings suggest a complex relationship between SREBP adherence, milestone achievement, and patient length of stay.

Conclusions:

  • A milestone-driven patient care pathway, supported by team rounding, was associated with reduced lengths of stay in the CVICU and hospital.
  • Milestone tracking reveals a more intricate association with patient outcomes than initially hypothesized.
  • Further research into SREBP implementation and milestone tracking offers opportunities to refine patient care pathways and enhance outcomes.
Abstract

Keywords:
bundled paymentcardiac surgeryhigh reliability organizationsintensive carequality improvement

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