Reduce Clinical Variation in SICU by Optimization of Post – Operative Cardiac Surgery Order-Set

From the 2024 HVPA National Conference

Muna Shehadeh BS (Johns Hopkins Aramco Health Care)

Introduction
Standardizing care in the immediate postoperative period allows anticipation of physiologic derangements and early recognition and avoidance of complications.

An Order Set helps create standardized clinical care and ensures clinical care is provided in a timely, effective, and cost-effective manner by utilizing available resources efficiently and consistently to deliver high-quality care based on evidence-based practice.

Define: Problem Statement

SICU staff used the patient safety assessment survey to report that there was variation in care during post-operative cardiac surgery care.

The CUSP team conducted a quality improvement initiative to review and update the current Order Set and audit compliance to ensure standardized care was being provided. The Comprehensive Unit-Based Safety Program (CUSP) is a five-step methodology to improve patient safety, quality of care, and outcomes.

Aim and Objectives:
To Review and update Post–Operative Cardiac Surgery Order Set by December 31, 2023

  1. Structure objective

By the end of October 2023, there will be an update to the Post–Operative Cardiac Surgery Order Set.

  1. Process objective

By the end of December 2023, the new Post–Operative Cardiac Surgery Order Set will be in the Production phase in EPIC.

  1. Outcomes objective

By the end of January 2024, the compliance of using the new Post–Operative Cardiac Surgery Order Set should be 100%.

Scope:
All ICU Patients who had Cardiac Surgery

Benefit:

  • Integrate and coordinate care by communicating best practices through multiple disciplines, levels of care, and services.
  • Modify practice through evidence-based care and reduce variation.
  • Enhance workflow with pertinent instructions that are easily understood.
  • Decrease medical errors through integrated safety alerts and reminders.
  • Compliance with Accreditation standards.
  • Decrease length of stay.
  • Improve patient outcome.

Analyze:

  1. Obtain management support.
  2. Obtain commitment from service.
  3. Form multidisciplinary key stakeholder team.
  4. Gather relevant information for the previous pathway.
  5. Establish aims.
  6. Establish outcomes for clinical practice guidelines order set evaluation.
  7. Design data collection for clinical practice guidelines order set utilization.

Measure:

Baseline process: Audit Utilization rate of the new Post–Operative Cardiac Surgery Order Set

Interventions/Next Steps

  • Obtain consensus for the newly developed order set.
  • Publish order set into EPIC production.
  • Provide education to clinical staff.

Study: Post Project

  • Commence use trial of newly developed clinical practice order set according to start time.
  • Audit order set to establish compliance and sustainability of pathway.
  • Analyze Audit & survey users.

Control:

  • Supply analysis of the clinical practice guidelines order set utilization and compliance.
  • Continue implementation.
  • Repeat audits at timely intervals.

References:

  • Management of post-op cardiac surgery patients | Department of Critical Care – McGill University
  • Postoperative care after cardiac surgery – UpToDate
  • Postoperative Care of the Cardiac Surgical Patient – PMC (nih.gov)