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

描述(由申请人提供)：该计划的总体目标是通过在一组医院中实施跨学科和多方面的患者安全计划来大幅降低心脏手术患者的死亡率、发病率和护理成本，CER证明了这一计划可以改善患者的预后。我们将在之前的努力基础上，在整个密歇根州改善患者的安全。我们计划使用相同的基于单元的模式，通过将来自医院内手术室(OR)、重症监护病房(ICU)和地板的基于单元的团队联系起来，来降低心脏手术的发病率和死亡率。我们与心血管麻醉学会基金会(SCAF)和胸科外科医生学会(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会向该数据库报告数据。他们的改进方法是向医院发送绩效报告，而不向团队提供改进干预(称为被动反馈)和基准数据。这种方法与我们的密歇根项目形成了鲜明对比，在密歇根项目中，团队积极实施了一个跨学科和多方面的患者安全计划，并收到了关于绩效的反馈。我们假设，就像STS所做的那样，表现数据的反馈与CER中展示的减少感染并发症的多方面干预以及改善心脏手术文化的计划相结合，将比单纯的被动反馈更大程度地减少30天的死亡率、住院时间和再入院。这项建议的具体目标包括：1.实施和评估患者安全计划对心脏手术患者队列中手术部位感染率和/或安全文化的影响。2.实施和评估患者安全计划对心脏外科ICU中心线相关血流感染、呼吸机相关肺炎和安全文化的影响。3.实施和评估患者安全计划对与从ICU移交到楼层和出院相关的错误的影响，以及与护理心脏外科患者的医院楼层队列中的安全文化的影响。4.在一组提供心脏手术的医院中，评估患者安全计划在心脏手术室、ICU和地板上的综合影响，与关于30天死亡率、再次住院和住院时间的结果数据的被动反馈相比。这项研究有可能大大减少心脏手术的死亡率、住院时间和再入院时间，并发展关于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绩效数据的影响与医院队列中跨学科和多方面的患者安全计划，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，实施并评估了一项安全计划对心脏手术患者30天死亡率、再入院和LOS的影响。这项研究有可能大大减少心脏手术的死亡率、住院时间和再入院时间，并发展关于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.