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

该计划的总体目标是大幅降低患者的死亡率、发病率和护理费用 通过实施跨学科和多方面的患者安全计划进行心脏手术， 在CER中证实，在医院队列中，可改善患者结局。我们将在先前努力的基础上 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， 通过连接手术室（OR）的单元团队，降低心脏手术的发病率和死亡率， 重症监护室（ICU）和医院内的楼层。我们与心血管学会合作， 麻醉基金会（SCAF）和胸外科医生协会（STS）进行和传播这一点， research. 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在其中。 报告数据。他们的改进方法是将绩效报告发送给医院， 改进干预措施（称为被动反馈）和基准数据。这种做法与 在我们的密歇根项目中，团队积极实施跨学科和多方面的患者 安全计划，并收到有关性能的反馈。我们假设 性能数据的反馈，如STS所做的那样，CER中展示了多方面的干预措施， 减少感染并发症和提高心脏手术文化的计划，将导致更大的 减少30天死亡率、住院时间和再入院率。具体目标 包括以下内容; 1.实施并评价患者安全计划对手术部位感染率的影响， 心脏手术室队列中的手术室安全文化。 2.实施并评价患者安全性项目对中心静脉导管相关性 血流感染、呼吸机相关性肺炎和心脏外科ICU的安全文化。 3.实施并评估患者安全计划对以下错误的影响： ICU到楼层和出院，并在医院楼层的队列中进行安全文化培训 专门照顾心脏手术病人 4.评价患者安全计划在心脏手术室、ICU和楼层中的综合影响， 被动反馈30天死亡率、再入院率和住院时间的结局数据， 在一群提供心脏手术的医院里 这项研究有可能大大降低心脏病患者的死亡率、住院时间和再入院率。 手术和发展有关如何提高病人安全的新知识。

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.