Multidisciplinary Quality Improvement team when empowered can reduce mortality in an extremely high risk patient population requiring ECMO
CCCF ePoster library. Masud F. Oct 31, 2016; 150905; 27
Dr. Faisal Masud
Dr. Faisal Masud
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Abstract
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Topic: Quality Assurance & Improvement

Multidisciplinary Quality Improvement team when empowered can reduce mortality in an extremely high risk patient population requiring ECMO


Ratnani, Iqbal MD, FCCP, FCCM; Masud, Faisal Masud MD, FCCP, FCCM; John E Fetter MD
Department of Anesthesiology and Critical Care, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas 77030



Abstract:

Introduction/Hypothesis:
Multidisciplinary Quality Improvement team, when empowered can reduce mortality in an extremely high-risk patient population. With an organized institutional process placement, marked improvement in mortality can be achieved by targeting a particular area of patient care.
 
Methods:
This retrospective study was conducted from 2012 to 2015 in a high volume single tertiary center to evaluate the impact of Quality Improvement Initiatives focusing on minimizing variability of care and impact on mortality for patients requiring Extra-Corporeal-Membranous-Oxygenation (ECMO).
 
CMPI committee was formed in 2013 in light of a very high mortality rate in this high-risk patient population requiring ECMO support. This was a multidisciplinary group involving surgeons, intensivist, cardiologist, pulmonologist, pharmacist, RT, nursing, and quality personnel, which over a period of time developed and implemented 1) Selection criteria, 2) Pharmacy managed anticoagulation protocol, 3) Mandatory ethics consults on all ECMO patients, 4) Process for family support, 5) Process for Hospice and 6) Participation in ELSO registry. Also included, 1) Training of ECMO specialists, 2) Development of VV ECMO weaning protocol, 3) Intensivist ownership of criteria documentation and 4) Development of ECMO admission order set. In 2015, 1) Anticoagulation protocol was extended to first 24 hours, 2) ECMO was approved for possible bridge to lung transplant, 3) Physical Therapy driven early ambulation was performed and 4) Frequency of blood draws were minimized.
 
Results:
In 2012, total ECMO mortality was 76% (73% for VV and 78% for VA) at our institution. After the implementation of the organized processes, order sets and protocols, overall mortality decreased to 51.30% (30% for VV and 82% for VA ECMO) in first year (2013), 41.5% (36% for VV ECMO and 58% for VA ECMO) in second year (2014) and 46.7% (40% for VV ECMO and 60% for VA ECMO) in third year (2015). Mortality in VV ECMO and VA ECMO significantly decreased from the year 2012 to 2015 (Chi-squared value=12.60, p-value=0.006). In similar years, the mortality rates at UHC was 53%, 53%, 51% and 53% respectively.
 
 
Conclusions:
After the implementation and continuous refinement of the established processes, education and protocols there was a substantial decrease in overall mortality as well as in both VV and VA ECMO which were lower compared to the mortality rates at UHC.
 
RT = Respiratory Therapist
ELSO = Extracorporeal Life Support Organization 
VV = Veno-venous
VA = Veno-Arterial
CMPI = Care Management Process Improvement Committee
UHC =University Health Consortium
 
 
Keywords:
Quality and patient safety, Education, ECMO, Protocol, Professional development


References:

'No references'



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