Preparing to Implement an ERAS Cardiac Surgery Value Quality Care Initiative

Most hospitals are exploring opportunities to improve outcomes and achieve positive financial results with bundled continuous quality improvement programs, but “Where to start?” is a common question. Bundled payment sets a single spending target for all applicable health care servicesprovided during a clinical episode of care over a specified time period. One way this is getting done in cardiac surgery is with MIPS and MACRA.  The goal of these changes is to create financial incentives that encourage hospitals and providers to coordinate care across treatment settings, reduce unnecessary services, and expand initiatives that can help patients recover quickly. High cost programs like post cardiac care will be the focus of many

Expert Consensus Opinion Suggest Preventing Retained Blood To Reduce Infections After Cardiac Surgery

All patients having heart surgery are required to have drainage catheters to remove shed blood from around the heart and lungs in the early hours of recovery following surgery. Evidence has shown that these drainage catheters have a high failure rate due to clogging. Chest tube clogging when a patient is still bleeding can lead to Retained Blood Syndrome (RBS). Retained blood can be demonstrated in up to 20% of patients after heart surgery. Patients with retained blood have far greater hospital acquired infections (HAI) after cardiac surgery. • Patients with interventions for retained blood had a four-times increase in overall infection rate when compared to patients without interventions for

ICU Bottlenecks after Cardiac Surgery: The case for active clearance of chest tubes

The world of heart surgery is fast paced for all involved. Elective patients are scheduled, emergent cases are added on, and both are sometimes bumped for emergency cases that present at the last moment and need immediate surgery. This makes it difficult to staff operating rooms and CVICUs in a manner that allows maximum efficiency of case throughput. Routine cases suffer the most delays when bottlenecks develop in the ICU. A bottleneck occurs when elective cases have to be delayed or rescheduled due to a lack of available beds in the CVICU. When this happens, teams go idle in the operating room and post ICU recovery wards, and patients and their families

Open Chest Tube Clearance of Clot: Is it safe? Is there a better way?

Chest tubes are required for all heart operations to evacuate shed blood from around the heart and lungs. Evidence suggests that nearly 36% of chest tubes can clog, preventing adequate blood evacuation and potentially leading to retained blood syndrome (RBS). But how do you keep chest tubes free of clot and working to evacuate shed blood? There are currently no published national standards, and thus nurses and ICU care givers are left to make bedside, makeshift efforts to address this common problem on their own. In addition to the questionable techniques of milking and stripping, one such bailout technique is open clearance of the chest tube once it is noticed

The Challenges of Keeping a Chest Tube Free of Clogging after Heart Surgery

Chest tubes are used on every case after heart surgery to drain blood from around the heart and lungs in the early hours of recovery.1,2  If there is any bleeding, or even oozing tissues, the blood must be immediately drained externally by the chest tubes. But chest tubes frequently clot, which can lead to Retained Blood Syndrome (RBS), which includes the need for re-interventions to wash out clot, remove blood or bloody fluid, or long term, even fibrosis around the heart or lungs.3,4  Blood, even in small volumes left around the heart after surgery can cause an inflammatory response, triggering complications such as Post Operative Atrial Fibrillation (POAF).5 Nurses have