Making Surgery Safer: Preventing Post Operative Myocardial Infarctions Loyola University Chicago LOYOLA UNIVERSITY HEALTH SYSTEM Making Surgery Safer: Preventing Post Operative Myocardial Infarctions Team Membership Clinical Departments: Anesthesia, General Surgery, Orthopaedics, Primary Care, and Urology Hospital Departments: Surgical Admitting Center, Operating Room, Post-Anesthesia Recovery, Pharmacy, and CCE

Opportunity Statement Patients at high risk of postoperative myocardial infarction will receive prophylactic treatment with beta-blockers unless there is a contraindication to this therapy Goal: To reduce postoperative myocardial infarctions

Most Likely Causes For The Current Opportunity Perioperative Beta blockade is recently identified in the literature as an approach to reduce cardiac complications Lack of awareness of new literature by LUHS physicians

Solutions Implemented Project chartered by the Quality & Patient Safety Committee of the LUHS Board Assembled project team Conducted a literature review Communicated with other organizations Drafted LUHS protocol

Perioperative Beta Blocker Protocol

Solutions Implemented Provided education to the following audiences: Anesthesia, Urology, Primary Care, Surgical Admitting Center, Post-Anesthesia Recovery, Inpatient Nurse Managers Implemented pilot with Urology patients December 1, 2002 Revised protocol and processes based on project data Added General Surgery patients to the pilot April 1, 2003

Progress To Date 48 patients have been enrolled; 41 have completed the protocol Hypertension is the most common risk factor

Progress To Date There is an opportunity to improve compliance with post operative orders and discharge orders Among patients completing the protocol there have been no postoperative MI’s

Progress To Date

Next Steps Continue data collection and analysis Identify barriers to successful completion of the protocol and implement solutions to resolve Reminders for postoperative and discharge orders Determine effectiveness of patient screening Revise protocol as needed Expand pilot to other surgical services