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Successes and Challenges

Successes and Challenges. QA initiatives. Lean projects Improving surgical wait list times Surgical check-list—site and procedure specific Critical incidents analysis Dealing with the pressure demands, are there areas we can be more efficient NSQIP—decreasing postoperative complications.

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Successes and Challenges

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  1. Successes and Challenges

  2. QA initiatives • Lean projects • Improving surgical wait list times • Surgical check-list—site and procedure specific • Critical incidents analysis • Dealing with the pressure demands, are there areas we can be more efficient • NSQIP—decreasing postoperative complications

  3. NSQIP data—Deciles (1-10)

  4. Importance of FEEDBACK

  5. Questions??

  6. Reduction in Postoperative Pulmonary Complications • Ventilator Acquired Pneumonia (PACU and CSICU). Establishing best practices. • Use of EVAC endotracheal tubes • Patients nursed 30 degree head up • Mouth care

  7. Aug 2012 Baseline Feb 2013 Post-ICOUGH

  8. Cardiac Surgery “Time-Out” • Between anesthesia and perfusion to enable a more patient specific approach to CPB prime and volume replacement • Volulyte, albumin, or crystalloid • GFR <50 • Size of circuit • Ultra-filtration/dialysis • Blood transfusion issues • Cerebral oxygenation issues including hemodynamic/hematocrit goals

  9. Debriefing & Anesthesia Emergence, and Handovers • Appropriate Timing • Standard operating procedures at anesthesia emergence—sterile cockpit • Discussion on pain management who is responsible for orders • Handover to PACU, CSICU, ICU

  10. Speakers • Dr MitraMaharaj—NSQIP Champion Langley, ENT • Dr Sam Bugis, St Paul’s general surgeon, BCMA representative • Dr Ron Collins, Kelowna, Anesthesiologist, ERAS lead • Dr Adrienne Melck, NSQIP Champion, St Paul’s, Endocrine surgeon

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