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Advancing cardiotomy suction practices for coronary surgery via multidisciplinary collaborative learning.

James W Stewart1,2, Donald Nieter3, Xiaoting Wu4

  • 1Department of Surgery, Yale School of Medicine, New Haven, Conn.

JTCVS Open
|February 29, 2024
PubMed
Summary

A quality improvement initiative successfully standardized stopping cardiotomy suction before protamine administration during coronary artery bypass grafting (CABG). This practice change improved patient safety without increasing adverse outcomes.

Keywords:
cardiac surgerycardiopulmonary bypassoutcomesquality improvement

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Area of Science:

  • Cardiovascular Surgery
  • Quality Improvement Science
  • Patient Safety

Background:

  • Professional standards suggest stopping cardiotomy suction before protamine administration during cardiopulmonary bypass.
  • Perceived safety concerns have historically limited adherence to this practice during coronary artery bypass grafting (CABG).

Purpose of the Study:

  • To evaluate a multidisciplinary, collaborative quality improvement intervention aimed at standardizing the practice of stopping cardiotomy suction before protamine administration in CABG.
  • To assess the impact of this intervention on clinical outcomes.

Main Methods:

  • A statewide intervention involving 32 centers in the PERForm Registry, including feedback and education, was implemented.
  • Four non-participating centers served as controls.
  • Changes in practice and associations with mortality, reoperation, and transfusion were analyzed using time-effect modeling and multivariable regression.

Main Results:

  • 80.7% of patients at Michigan centers achieved the target practice.
  • Significant improvements in practice were observed post-intervention, with no increase in adverse outcomes.
  • Michigan centers showed a significantly greater improvement in practice compared to non-Michigan centers within 7 months.

Conclusions:

  • Multidisciplinary collaborative quality improvement is effective in promoting evidence-based cardiotomy suction practices.
  • The intervention successfully advanced agreed-upon practices without negatively impacting patient morbidity or mortality.