A. L. Lubitz1, J. A. Shinefeld1, T. A. Santora1, A. Pathak1, E. E. Craig1, A. J. Goldberg1, H. A. Pitt1 1Temple University,Philadelpha, PA, USA
Introduction: Postoperative respiratory failure is an uncommon, but deadly and costly complication. Approximately 30% of patients who suffer this complication die, and the excess cost is estimated to be $50,000.00 per patient. The aim of this analysis is to document that a multidisciplinary Safer Surgery approach can reduce the incidence of postoperative respiratory failure.
Methods: Postoperative respiratory failure was monitored in both the Vizient (University HealthSystem Consortium) and the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) databases. In Vizient the Patient Safety Indicator (PSI)-11 documents the observed (O) rate per 1,000 cases, the expected (E) rate per 1,000 cases, and the O/E ratio for postoperative respiratory failure. PSI-11 data were monitored from Fiscal Years (FY) 2014-2017. In the ACS-NSQIP database both unplanned intubation and ventilation greater than 48 hours are reported as odds ratios and deciles. Data in the 10th decile are classified as “Need Improvement” while 2nd to 9th decile outcomes are “As Expected.” Safer Surgery is a multidisciplinary initiative whose aim is to optimize the preoperative, intraoperative and postoperative phases of care. Patient education and preparation are key elements in this program, as are surgeon, anesthesiologist and nursing interventions. The RECOVER mnemonic was developed to emphasize: R-review materials, E-expand your lungs, C-cough and deep breath, O-oral care, V-vary activity, E-eat safely and R-rest with the head of the bed up. Educational materials are distributed to patients in surgery clinics, Preanesthesia Testing (PAT) and via the patient portal of our electronic medical record system. Multimedia educational materials were produced for patients, residents and nursing staff.
Results:Patient Safety Indicator (PSI)-11 O/E Ratio decreased from 1.36 in FY 14, to 0.77 in FY 15, to 0.48 in FY 16 to 0.43 in FY 17 (Table 1). The Observed PSI-11 mortality was 30% in the first 18 months of the analysis and decreased to 15% in the most recent 18 months. These improvements represent a savings of 11 lives and $1.5 million dollars. Both the ACS-NSQIP unplanned intubation and ventilator greater than 48 hours needed improvement in FY 15 (Table 1). Both of these metrics have improved to “As Expected” in FY 16 (Table 1).
Conclusion:A multidisciplinary Safer Surgery program improved postoperative respiratory failure outcomes at an academic medical center. A bundle of preoperative, intraoperative and postoperative best practices resulted in improved respiratory outcomes.
