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Acute Coronary Syndrome IV: Interprofessional Care

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IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
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Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
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Implementation of a Consensus-Driven Quality Improvement Protocol to Decrease Length of Stay after Elective Carotid

Zach M Feldman1, Srihari K Lella1, Sujin Lee1

  • 1Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.

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|June 24, 2023
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Summary
This summary is machine-generated.

A quality improvement protocol reduced the percentage of patients with extended length-of-stay (LOS) after carotid endarterectomy (CEA) by 40%. This initiative focused on managing postoperative hypertension and urinary retention to improve patient outcomes.

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Area of Science:

  • Vascular Surgery
  • Quality Improvement Science
  • Health Services Research

Background:

  • National guidelines recommend a postoperative length-of-stay (LOS) of 1 day for elective carotid endarterectomy (CEA).
  • Gaps in perioperative care coordination can hinder achieving this target LOS.
  • Urinary retention and postoperative hypertension were identified as key factors increasing CEA LOS at the institution.

Purpose of the Study:

  • To design and implement a quality improvement (QI) protocol to reduce postoperative LOS after CEA.
  • To address specific issues of urinary retention and postoperative hypertension contributing to prolonged LOS.
  • To improve institutional performance in meeting the 1-day LOS goal for CEA.

Main Methods:

  • A QI protocol using two Plan-Do-Study-Act (PDSA) cycles was implemented.
  • The protocol standardized antihypertensive medication management preoperatively and through postoperative day 1.
  • Alpha-1 blockade was administered preoperatively to all male patients.

Main Results:

  • The percentage of patients with LOS >1 day decreased from 58.3% to 32.8% (P=0.01).
  • Adherence to the antihypertensive medication protocol was 89.8%, and preoperative alpha-1 blockade adherence was 78.8%.
  • There was no significant difference in 30-day readmission rates between pre- and post-intervention cohorts.

Conclusions:

  • A consensus-driven QI protocol significantly improved the rate of achieving a 1-day postoperative LOS after CEA.
  • The protocol demonstrated a ~40% improvement in the primary outcome measure.
  • Future efforts to reduce CEA LOS should prioritize minimizing postoperative hypertension and urinary retention.