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Quality improvement interventions using EMRs reduce postoperative AF
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Patients undergoing cardiac surgery experience fewer incidences of postoperative atrial fibrillation and a reduction in length of hospital stay and cost when quality improvement interventions using electronic medical records are implemented, researchers reported in Circulation: Cardiovascular Quality and Outcomes.
The quality improvement process detailed in the case study included four steps:
Identifying stakeholders
To spearhead the quality improvement project, the researchers first created a stakeholder committee that consisted of cardiologists, cardiothoracic surgeons, nursing staff and administrative staff.
Retrospective analysis
The committee then conducted a retrospective analysis of patients undergoing CABG with or without valve surgery between 2009 and 2011 using the Allina health system’s integrated electronic medical records (EMRs). The data revealed that the overall composite incidence of postoperative AF was 29.8% — 30.2% in elective cases and slightly higher in valve surgeries. The median length of hospital stay for patients who developed postoperative AF was longer than for those patients who did not develop it (7 days vs. 5 days; P < .001). The median cost of elective surgeries in which the patient developed postoperative AF was also higher ($18,370 vs. $15,875; P < .001).
Literature review and modeling
The stakeholder committee then, through a guideline and literature review, chose prophylactic amiodarone therapy as the preferred intervention. Using five cost-savings prediction models, the committee estimated the reduction in length of hospital stay and total cost saved if a 50% or 100% rate reduction of postoperative AF after elective surgery was achieved.
Protocol development and implementation
When the quality improvement intervention was implemented at the pilot institution, Abbott Northwestern Hospital, in April 2013, the protocol required all patients undergoing elective cardiac surgery to attend a preoperative visit where the physician could determine whether the patient should be prescribed amiodarone using an EMR-based support tool, the researchers wrote.
In the first 3 months of implementation, of 156 elective cardiac surgeries, 27 patients qualified for prophylactic amiodarone during a preoperative visit. Patients who received amiodarone had lower rates of postoperative AF than patients who had the evaluation but did not qualify for amiodarone and patients who did not undergo the evaluation (11.1% vs. 38.7% and 38.8%, respectively; P = .022).
“Given the reductions in the [postoperative AF] rates, the protocol was expanded to all [three] hospitals [with independent CV surgery programs] in the Allina system,” the researchers wrote.
“As health care costs continue to grow, the importance of using data and guidelines to improve quality and decrease cost becomes ever more vital,” they wrote. “This study demonstrates how collaborative effort can identify easy targets for intervention, develop plans to combat them, and model the expected outcomes.” – by Tracey Romero
Disclosure: The researchers report no relevant financial disclosures.
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