1. Making Surgery Safer: Preventing Post Operative Myocardial Infarction Departments: Anesthesia, Cardiology, General Surgery, Orthopaedics, Primary Care, Urology, SAC, OR, PAR, Pharmacy, and CCE Loyola University Chicago LOYOLA UNIVERSITY HEALTH SYSTEM

2. Opportunity Statement There is an opportunity to reduce the risk of postoperative myocardial infarction in high-risk patients undergoing major surgical procedures. The objectives of this project are: 1.To ensure that all high-risk patients receive perioperative beta-blocker therapy 2.To reduce the incidence of postoperative myocardial infarction in high-risk patients.

3. Most Likely Causes Perioperative beta-blockers have not been routinely given at LUHS because: This practice has been only recently identified in the literature as an approach to reduce cardiac complications Lack of awareness of new literature by some LUHS physicians

4. Solutions Implemented: Implemented the LUHS Perioperative Beta-Blocker protocol: Urology – December 2002Urology – December 2002 General Surgery – April 2003General Surgery – April 2003 Vascular – August 2003Vascular – August 2003 Complex spine procedures – January 2004Complex spine procedures – January 2004 Renal Transplants – March 2004Renal Transplants – March 2004 Ongoing revisions to the protocol Ongoing education to physicians, residents, and nurses

5. Solutions Implemented Improved the Preadmission Testing screening process to ensure that all high-risk patients are put on the protocol Improved visibility and access to the protocol: Protocol orders made available on the EMR and LUCI Added protocol orders to existing standing orders when appropriate Posted signs on the PAR computers

6. Results & Analysis 259 patients have completed the protocol 1.5% rate of postoperative myocardial infarction No mortality Decreasing rate of postoperative myocardial infarction in all LUHS major surgeries

7. LUHS Postoperative Acute Myocardial Infarction Rate LUHS UHC Population Mean The overall LUHS postoperative acute myocardial infarction rate for all major surgeries is on the decline and approaching for all major surgeries is on the decline and approaching the UHC comparison rate Project Started

8. Recommendations & Next Steps Revise the protocol and orders as needed Add protocol orders to all applicable postoperative order sets Expand protocol to all surgical services by July 04 Continue efforts to educate and improve visibility of the protocol