Cardiac Team Performance: Are You As Good As You Think You Are?

“I have taken a 14+ page form and reduced it to it’s 1 page bare essentials…”

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Editor’s Note:

I had an interesting discussion with one of our cardiac anesthesiologists the other day. We were talking about our cardiac program’s outcomes, and the fact that I felt our program needed to promote what I considered a very strong OpCab program, and that the subsequent reduction of our transfusion rate (roughly 4-fold) translated in my opinion- to a huge plus in terms of cost savings and a reduction in exposure to risk for our patient population.

His response was that the numbers were great- but we hadn’t seen or realized postoperative graft patency rates with our off-pump population as opposed to the on-pump ACB (AortoCoronay Bypass) numbers.

I countered that with the point that we had seen no returns on patient re-operations for graft occlusions, but admittedly it would take a few more years to make a sound assessment. As well, I was adamant that our primary surgeon was better than any other heart surgeon I had seen at 30 prior hospitals, in terms of his skill in managing off-pump ACB’s.

It is also clear that it is NOT purely the surgeon that enables these outcomes, but a combination of some serious talent on the surgical team as well. The first assistant, anesthesiologist, scrub tech, 2nd assistant, and circulating nurse make the difference on whether or not you will remain off-pump, or go on emergently.

As well, I also reviewed other aspects of how we approached our mission, in terms of quality improvement, and realized that a substantial piece of the puzzle, was our involvement as perfusionists regarding STS data collection, and that we had taken the leadership role in terms of all STS data collection about three years ago in 2010.

I had always considered myself to be very thorough regarding my preparation for an open heart procedure. Once I started to engage the template that STS requires in terms of data collection, I realized that in essence, this STS data collection form represented a “patient checklist” so to speak, and thereby, my own clinical awareness was substantially improved after literally being “forced” to review areas of the H&P that I may not have visited had I not been in charge of making sure that STS section was reviewed and documented.

So anyway, over the past three years, I have taken a 14+ page form and reduced it to it’s bare essentials in terms of a data collection tool, and highly recommend it to anyone involved with STS data collection, or placing patients on CPB.

It helps put you in charge of your responsibility to the patient, and certainly lends credibility- (using a recent example) when you are able to inform the surgeon of incidental issues such as left sided subclavian stenosis, that would make an IMA harvest irrelevant as well as ineffective.

Take a look at it- and see what you think. 🙂

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The Society for Thoracic Surgery (STS) national cardiac database is the all-consummate monster of consolidated data requirements that most cardiac programs subscribe to.

To be left off of the report card, is to be isolated and not assembled for review on the national slate, and that can be financially devastating as well as have serious implications as to what range of procedures your institution will ultimately be allowed to offer it’s client population (the patients).

If you are interested in improving your outcomes, email me for the form.

[email protected]

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