Heart and Vascular Institute team excels at key post-surgery measures
A Penn State Heart and Vascular Institute team successfully removed the breathing tubes of 121 cardiac surgery patients in the operating room (OR) from July to December 2020, achieving a 44.5% OR extubation rate. That’s a 985% improvement from the prior six months.
Even better, the team has achieved a reintubation rate of 2.7%, lower than the published rate of between 3.7% to 10% for various types of cardiac surgery, an indicator that earlier extubations are safe and effective.
“When I tell cardiac surgery patients there’s a good chance we can get them off the breathing machine in the OR, they’re comforted,” said cardiothoracic surgeon Dr. Jeffery Cope of Hershey Medical Center. “And when patients are less anxious, their outcomes are better.”
Traditionally, most cardiac surgery patients have their breathing tube removed while they recover in the Intensive Care Unit (ICU). But being awake for the extubation process creates pain and anxiety for patients.
That’s why the team of caregivers from cardiac surgery, cardiac anesthesia and the ICU began the quality improvement project in July 2020. A key factor in the team’s success is the development of an opioid-free pathway that includes the use of non-narcotic nerve blocks.
“Extubations are most successful when patients can breathe comfortably, and our pain pathway is helping them do just that,” Cope said.
In addition to improving pain control and reducing patient stress, earlier extubations also create the potential for shorter lengths of stay after cardiac surgery.
“This is the very definition of patient-centered care,” said Dr. Michael Roberts, chief of the Division of Cardiothoracic Anesthesiology at Hershey Medical Center. “I believe we’re one of the few centers in the world doing this and doing it so well.”
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