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、发病率和护理成本。 通过实施跨学科和多方面的患者安全计划进行心脏手术， 在一组医院的CER中展示了改善患者结局的效果。我们将在先前努力的基础上再接再厉 以提高密歇根州患者的安全。我们计划使用相同的基于单位的模型来 通过将手术室(OR)的单元团队联系起来，降低心脏手术的发病率和死亡率， 重症监护病房(ICU)，以及医院内的楼层。我们与心血管学会合作 麻醉基金会(SCAF)和胸科外科医生学会(STS)进行和传播这项工作 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可以进入这个数据库。 报告数据。他们的改进方法是将业绩报告发送到医院，而不提供 改进干预措施(称为被动反馈)和对团队的基准数据。这种方法形成了鲜明的对比 在我们的密歇根项目中，团队积极实施了一名跨学科和多方面的患者 安全计划，并收到有关性能的反馈。我们假设这两个因素的结合 反馈绩效数据，就像STS所做的那样，在CER中展示了多方面的干预措施 减少感染并发症和改善心脏手术文化的计划，将产生更大的 与单纯的被动反馈相比，30天的死亡率、住院时间和再入院时间都有所减少。具体目标 这项建议包括以下内容； 1.实施和评估患者安全计划对手术部位感染率和 或心脏手术患者队列中的安全文化。 2.实施和评估患者安全计划对中心线相关死亡率的影响 心脏外科ICU中的血流感染、呼吸机相关性肺炎和安全培养。 3.实施和评估患者安全计划对与移交有关的错误的影响 ICU到楼层和出院，以及在医院楼层队列中的安全文化 为心脏手术病人提供护理的医院。 4.评估患者安全计划在心脏手术室、ICU和FLOOR中的综合影响 被动反馈关于30天死亡率、再次住院和住院时间的结果数据， 在一批提供心脏手术的医院中。 这项研究有可能显著降低心脏手术的死亡率、住院时间和再住院时间。 并开发有关如何提高患者安全性的新知识。

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.