Translating CER results from ICU study to improve outcomes in cardiac surgery

描述（由申请人提供）：本项目的总体目标是通过实施一项跨学科和多方面的患者安全性项目，在一组医院中大幅降低心脏手术患者的死亡率、发病率和护理成本，CER中证实了该项目可改善患者结局。我们将建立在我们先前的努力，以提高整个密歇根州的病人安全。我们计划使用相同的基于单元的模型，通过连接来自手术室（OR）、重症监护室（ICU）和医院内楼层的基于单元的团队来降低心脏手术的发病率和死亡率。我们与心血管麻醉基金会（SCAF）和胸外科医生协会（STS）合作开展和推广这项研究。STS有一个成熟的数据库，美国大多数进行心脏手术的医院都向其中报告数据。他们的改进方法是将绩效报告发送给医院，而不提供改进干预措施（称为被动反馈）和基准数据给团队。这种方法与我们的密歇根项目形成鲜明对比，在该项目中，团队积极实施跨学科和多方面的患者安全计划，并收到有关绩效的反馈。我们假设，与STS所做的那样，将性能数据的反馈与CER中证明的减少感染并发症的多方面干预和改善心脏手术文化的计划相结合，将导致30天死亡率、住院时间和再入院率的降低，而不是单独的被动反馈。该提案的具体目标包括以下内容：1。在心脏手术室队列中实施并评价患者安全计划对手术部位感染率和手术室安全文化的影响。2.实施并评价患者安全计划对心脏外科ICU中心静脉导管相关血流感染、呼吸机相关肺炎和安全文化发生率的影响。3.实施并评价患者安全计划对与从ICU到楼层和出院相关的错误以及护理心脏手术患者的医院楼层队列中的安全文化的影响。4.在提供心脏手术的医院队列中，评价患者安全性计划在心脏手术室、ICU和楼层中的综合影响，并与30天死亡率、再入院率和住院时间结局数据的被动反馈进行比较。这项研究有可能大大降低心脏手术的死亡率、住院时间和再入院率，并开发有关如何提高患者安全性的新知识。 公共卫生相关性：该计划的总体目标是通过比较被动报告性能数据与医院队列中跨学科和多方面患者安全计划的影响，大幅降低心脏手术患者的死亡率、发病率和护理成本。我们与STS和SCAF合作，实施并评估安全性计划对心脏手术患者30天死亡率、再入院率和LOS的影响。这项研究有可能大大降低心脏手术的死亡率、住院时间和再入院率，并开发有关如何提高患者安全性的新知识。

DESCRIPTION (provided by applicant): The overall goal of this program is to substantially reduce the mortality, morbidity, and costs of care in patients having cardiac surgery by implementing an interdisciplinary and multifaceted patient safety program, demonstrated in CER to improve patient outcomes, in a cohort of hospitals. We will build upon our prior efforts to improve patient safety throughout the state of Michigan. We plan to use the same unit-based model to reduce morbidity and mortality in cardiac surgery by linking unit-based teams from the operating room (OR), intensive care unit (ICU), and floor within a hospital. We partnered with the Society for Cardiovascular Anesthesia Foundation (SCAF) and the Society for Thoracic Surgeons (STS) to conduct and spread this research. The STS has a mature database into which most hospitals performing cardiac surgery in the U.S. report data. Their approach to improvement is to send performance reports to hospital without offering improvement interventions (termed passive feedback) and benchmark data to teams. This approach contrasts with our Michigan project, in which teams actively implemented an interdisciplinary and multifaceted patient safety program and received feedback regarding performance. We hypothesize that the combination of feedback of performance data, as STS has done, with a multifaceted intervention demonstrated in CER to reduce infectious complications and a program to improve culture in cardiac surgery, will result in a greater reduction in 30-day mortality, length of stay, and readmissions than passive feedback alone. The specific aims of this proposal including the following; 1. To implement and evaluate the impact of a patient safety program on rates of surgical site infections and OR safety culture in a cohort of cardiac ORs. 2. To implement and evaluate the impact of a patient safety program on rates of central line-associated bloodstream infections, ventilator-associated pneumonia, and safety culture in cardiac surgical ICUs. 3. To implement and evaluate the impact of a patient safety program on errors associated with handoffs from the ICU to the floor and discharge from the hospital, and with safety culture in a cohort of hospital floors that care for cardiac surgical patients. 4. To evaluate the combined impact of a patient safety program in cardiac ORs, ICUs, and floors compared to passive feedback of outcome data on 30-day mortality, hospital readmissions, and hospital length of stay, in a cohort of hospitals providing cardiac surgery. This study has the potential to substantially reduce mortality, length of stay, and readmissions in cardiac surgery and to develop new knowledge regarding how to improve patient safety. PUBLIC HEALTH RELEVANCE: The overall goal of this program is to substantially reduce the mortality, morbidity, and costs of care in patients having cardiac surgery by comparing the impact of passive reporting of performance data to an interdisciplinary and multifaceted patient safety program in a cohort of hospitals. We partnered with the STS and SCAF to implement and evaluate the impact of a safety program on 30 day mortality, readmission and LOS in patients having cardiac surgery. This study has the potential to substantially reduce mortality, length of stay, and readmissions in cardiac surgery and to develop new knowledge regarding how to improve patient safety.