Kevin W. Lobdell, MD
Acute renal failure (ARF) after cardiac surgery has occurred in as many as 5 percent of patients and is associated with higher risk of death or complications and with prolonged intensive care unit (ICU) stays and hospitalization. Combined, these factors cost hospitals about $50,000 per patient.
To reduce ARF rates in patients, teams from Carolinas HealthCare System’s Sanger Heart & Vascular Institute developed a multidisciplinary, data-driven Adult Cardiac Surgery Quality Improvement Program. For the fifth time since its 2004 founding, the program has been awarded ”3 Stars,” the highest ranking recognition granted by the Society of Thoracic Surgeons, an honor reserved for the top 15 percent of institutions.
From 2003 to 2012, the ARF rate at Carolinas Medical Center dropped 7.3 percent. In 2012, the rate fell to 1.7 percent, significantly lower than the national average.
Led by Kevin W. Lobdell, MD, director of quality for Sanger, the program uses methodical and consistent quality metrics to improve outcomes and operational efficiencies, including:
• Early extubation – fewer than six hours after arrival to the ICU
• Protocols for computerized euglycemia and blood management while using goal sheets and multidisciplinary rounds to improve communication and reliability
• Focus to reduce ARF rates by developing a risk-scoring system
• Clinical education about a patient’s risk level and use of best evidence-based practices
“We monitor actions and key performance indicators to achieve our common goals,” Dr. Lobdell said. “For example, very small changes in post-operative kidney function are associated with increased risk of death. Hence, we assess a patient’s risk before and precisely monitor after surgery, mitigating risks at all times.”
The program’s efforts also correlate with improvement in early extubation, mortality and major complications. Early extubation rates increased from 69 percent in 2008-2010 to nearly 90 percent in 2011, more than 2.5 times the national average.
CMC: Early Extubation-Historic Perspective
CMC: Outcomes-Historic Perspective