1. Successes and Challenges

2. QA initiatives Lean projects Improving surgical wait list times
Surgical check-list—site and procedure specific
Critical incidents analysis
Dealing with the pressure demands, are there areas we can be more efficient
NSQIP—decreasing postoperative complications
All these areas require great team work and good communication between the “players”

3. NSQIP data—Deciles (1-10)

4. Importance of FEEDBACK
Does passive dissemination of data on quality indicators alone is sufficient to stimulate improvement or whether it would be part of mulit-component QI framework, which involves individual feedback

5. Questions??

6. Reduction in Postoperative Pulmonary Complications
Ventilator Acquired Pneumonia (PACU and CSICU). Establishing best practices.
Use of EVAC endotracheal tubes
Patients nursed 30 degree head up
Mouth care

7. We have adopted a program developed Boston Medical Center which was presented at NSQIP meeting. Uses the numonic ICOUGH

8. Aug 2012 Baseline Feb 2013 Post-ICOUGH
Blue – pre Aug 2012
Green post Feb 2013
To assess use of ICOUGH bundle, a pre-implementation audit was done in summer 2012 – in blue.
The first post-implementation audit Feb 2012 is seen in green.
Overall, much improvement in the use of pneumonia prevention strategies!
We are very happy and motivated by these first early results and greater use of best practice.
Also encouraging to see Patient Education from 25-95%, as it reflects a positive change in the type of relationships and exchanges developing at the bedside.
Aug 2012 Baseline Feb 2013 Post-ICOUGH

9. Overall trending of the PNA rate for T89
Overall trending of the PNA rate for T89. Our data is showing a decrease in our PNA rates since the forming of and ongoing hard work of the action team. A 50% reduction by June was the original goal, so we are keeping an eye on that so stay tuned for ongoing updates! We are heading in the right direction.

10. Cardiac Surgery “Time-Out”
Between anesthesia and perfusion to enable a more patient specific approach to CPB prime and volume replacement
Volulyte, albumin, or crystalloid
GFR <50
Size of circuit
Ultra-filtration/dialysis
Blood transfusion issues
Cerebral oxygenation issues including hemodynamic/hematocrit goals
Coming on the heels of recent studies questioning the safety profile of starches in crittically ill pts and those with compromised renal function, you will have the option of choosing what type of prime to use.
Blood transfusion issues—antibodies, JS, plasma in pump

11. Debriefing & Anesthesia Emergence, and Handovers
Appropriate Timing
Standard operating procedures at anesthesia emergence—sterile cockpit
Discussion on pain management who is responsible for orders
Handover to PACU, CSICU, ICU

12. Speakers Dr Mitra Maharaj—NSQIP Champion Langley, ENT
Dr Sam Bugis, St Paul’s general surgeon, BCMA representative
Dr Ron Collins, Kelowna, Anesthesiologist, ERAS lead
Dr Adrienne Melck, NSQIP Champion, St Paul’s, Endocrine surgeon