1 / 31

Today’s Webinar will begin at 11:00

Join the Enloe Medical Center webinar on blood conservation in CABG surgery for insights from experts and to learn about evidence-based standards for improved patient outcomes.

bobbyhall
Download Presentation

Today’s Webinar will begin at 11:00

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Today’s Webinar will begin at 11:00 2/9/12

  2. Welcome from Barb DeBaun, RN, MSN, CIC

  3. Introduction • Please do not put your phone on hold; use the mute function or *6 • Please type questions into text box • If time permits, we will open up the phone lines at the conclusion of the presentation

  4. Blood Conservation in CABG Surgery February 9, 2012

  5. Participants • Barry Johnson, MD • CV Surgery Anesthesiologist • barryjonsn@aol.com • Pablo Zubiate, CCP • Cardiovascular Surgery Coordinator • Pablo.zubiate@enloe.org • Marcia Nelson, MD, FAAFP • Vice President, Medical Affairs • Marcia.nelson@enloe.org

  6. Perspective • Historically, >50% of bypass surgeries transfused • Lundy’s hemoglobin threshold of 1942 • Study recommended transfusion for Hb < 8-10 • New studies focus on safety • Enloe creating new evidence-based standards

  7. The Public is Watching Wall Street Journal, October 19, 2010

  8. Enloe Medical Center • 298-bed Level II Trauma Center • 14,500 admissions/year • Planetree affiliate • Hospital-owned Flight Care • New Magnolia Tower Spring 2012 • New CV ICU • Doubles the number of OR suites

  9. Quality at Enloe • Created organizational focus in 2009 • Annual Quality Summit • Organizational quality initiatives • Program-based poster presentations

  10. Enloe Heart Program • Blue Distinction for Cardiac Care • STEMI Receiving Center • Cardiology, Interventional Cardiology, Electrophysiology • Cardiac Surgery

  11. Cardiothoracic Surgery Team • Surgeons • Miguel Puig, MD • Guy Lemire, MD • Phil Faraci, MD • Anesthesiologists • Barry Johnson, MD • Michael Hieb, MD • Jeni Henrie, MD • Robert Ertner, MD • Roger Phillips, MD • Physician Assistants • Shari Miller, PA-C • Michael Mohr, PA-C • Todd Richter, PA-C • Perfusionists • Pablo Zubiate, CCP • Bob Hayes, CCP • Jack Reed, CCP

  12. Background: CV Quality Initiative • Model: Physician champion leading multi-disciplinary team • Administration alignment • Evidence-based decision making • 2007 Guidelines published by the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologist Ann Thorac Surg 2007;83:27-86 • 2011Guidelines Update published Ann Thorac Surg 2011;91:944–82

  13. Project Design • Transfusion Committee oversight • Step 1: 2007-09 data analyzed • Step 2: Opportunities for improvement identified and goals set • Step 3: Physician champions established • Step 4: Education provided including new predictors for blood usage

  14. Special Considerations • Advanced age • Low pre-op RBC volume – anemia, small body size • Pre-op antiplatelet or antithrombotic drugs • Re-operative, complex procedures • Emergency operations • Non-cardiac co-morbidities • Inherited coagulation abnormalities

  15. Enloe Heart Program Volumes

  16. Baseline Data: 2007-2009 • In 2009, 65% of Enloe’s CABG patients received intra-operative blood • Goal: Reduce intra-operative blood usage to meet STS benchmark

  17. Methods: Role of the Team • Multidisciplinary blood conservation program • Surgeon role • Selective use of off-pump technique for CABG • Utilize evidence-based transfusion indications • Topical agents and tissue glues • Prophylaxis • Interventions outside the OR

  18. Methods: Role of the Team • Anesthesiologist Role • Hemostatic drugs with anti-fibrinolytic properties • Aprotinin, Amicar, Tranexamic acid • Erythropoietin ( EPO ) • DDAVP and Factor VIIA • Intra-operative autologous blood donation

  19. Methods: Role of the Team • Perfusionist Role • Minimize extracorporeal circuits • Use of bonded circuits • Use of cell savers • Pump salvage & intra-op auto-transfusion • Post-operative shed blood re-infusion • Retrograde autologous priming (RAP) • Hemofiltration

  20. Methods: Role of the Team • Physician Assistants • Endoscopic vein harvesting • Latest equipment to prevent hemorrhage • Vein mapping • Post-op transfusion guidelines • Nursing • ICU processes and practices

  21. Actions Taken • Reintroduction of guidelines • Review of blood utilization practices led to new protocols • Acquisition of new cell savers • Reduction of perfusion circuit • Anesthesia reduced crystalloid use

  22. CABG: On vs. Off Pump

  23. Results: 2009-Current CABG blood use decreased by 57% from 2009

  24. Next Steps • February 13 pilot: Thromboelastograph (TEG) in CABG surgery • Educate non-CV surgeons and OR staff around cell saver use

  25. Challenges • Evolution of protocols • Dealing with high-risk profiles • Introduction of new thrombin inhibitors

  26. Thank you Any questions?

  27. Next Cynosure ‘Beyond SCIP” and other events • March 15th: in-person meeting in San Francisco • March 27th: webinar with Dr. Heather Young from Colorado • April 12th: webinar with Sue Barnes from Kaiser Permanente • May 21st: Cynosure Summit: the great quality swap meet

  28. Improvement Capacity Building

  29. Contact Us • www.Cynosurehealth.org • Contact Barb DeBaun at bdebaun@cynosurehealth.org • Check in for updates on webinar and in-person meetings

More Related