Tools for Optimal Preoperative Preparation Strong for Surgery. Thomas K. Varghese Jr. MD, MS,
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1 Tools for Optimal Preoperative Preparation Strong for Surgery Thomas K. Varghese Jr. MD, MS,
2 None Disclosures
3 Achieving Quality and Safety in the Five Phases of Care Preoperative and Immediate Preoperative Thomas K. Varghese Jr. MD, MS, July 22, 2018
4 Why? How? What?
5 Why? How? What?
6 Phases For Perioperative Care
7 Phases For Perioperative Care Pre Op, Immediate Pre Op, Intraoperative, Post Op, Post Discharge
8 Phases For Perioperative Care Pre Op, Immediate Pre Op, Intraoperative, Post Op, Post Discharge Enhanced Recovery Program
9 Raising Awareness Changing Practice
10 Behavior Change in the 21 st Century Public health campaign focused on surgeons, patients and other important stakeholders + Implementation Bundles Interactive tools (checklists) to help optimize patients prior to surgery Integrated into workflow Surveillance and data feedback
11 Blood sugar control Medications Smoking Cessation Optimizing nutrition
12 Nutrition Screening for malnutrition Testing Albumin levels for risk stratification Evaluating for evidence-based use of immunonutrition Blood Sugar Screening for risk of diabetes Screening for blood sugar Monitoring perioperative glucose management Smoking Screening to identify smoking habits & history Advising patient on how to establish a quit plan Medications Identification of drugs that could cause bleeding & cardiac risks Reconciling herbal medications
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14 Blood Sugar Control Medications Smoking Cessation Optimizing Nutrition Safe & Effective Pain control Prehabilitation Patient Directives Delirium Screening
15 Next Four Modifiable Areas: Pain Control Appropriate Pain Control Strategies for those w/ Chronic Pain Return of unused pain medications Prehabilitation Screening for frailty Screening for Cardiac disease Screening for Pulmonary disease Enhancing physical function Patient Directives Advance Directive Financial Health Shared Decision Making Delirium Screening Assessment Review medications
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22 Implementation
23 Program Implementation Hospital/Clinic Expectations: Change team formation Commitment through postimplementation Strong For Surgery: Workflow Mapping
24 Explore Phases of Implementation Needs Assessment Engage with stakeholders, Form relationships, Identify local barriers
25 Phases of Implementation Explore Needs Assessment Engage with stakeholders, Form relationships, Identify local barriers Initiate Action Convene Change Team Focus on initial team & infrastructure
26 Phases of Implementation Explore Needs Assessment Engage with stakeholders, Form relationships, Identify local barriers Initiate Action Convene Change Team Focus on initial team & infrastructure Learn Together Surveillance and Feedback Action plans for maintenance
27 Effectiveness
28 Washington State Immunonutrition Use Q S4S Hospitals 85.4% (540/632) Elective Colorectal Procedures (w/anastomosis) Thornblade L, Varghese T, et al. Dis Col Rectum 2017; 60(1):68-75
29 Immunonutrition Use Q Washington State 85.4% (540/632) Elective Colorectal Procedures (w/anastomosis) CAE (Reintervention, Infection, Anastomotic Leak ± death) Patient who did not receive immunonutrition: 9.5% Patients receiving immunonutrition: 7.0%* Thornblade L, Varghese T, et al. Dis Col Rectum 2017; 60(1):68-75 [Q to Q4 2014] n=8,680 p = 0.04
30 Washington State Immunonutrition Use Propensity Score Matching (346 pts each group) CAE No immunonutrition: 11.6% Immunonutrition use: 7.2% (p=0.05) Length of stay No immunonutrition: 6.9 days Immunonutrition use: 5.8 days (p<0.01) Thornblade L, Varghese T, et al. Dis Col Rectum 2017; 60(1):68-75
31 Cigarette Smoking and Spine Fusion Surgery Bartek M, et al. Under Review JAMA Surgery
32 Cigarette Smoking and Spine Fusion Surgery Bartek M, et al. Under Review JAMA Surgery
33 Adoption
34 Pilot Year
35 sites, 206 surgeons 50 practices, 205 surgeons General, Colorectal, Bariatric, Spine, Thoracic, Vascular Surgery General, Colorectal, Plastic, Bariatric, Spine, Thoracic, Vascular Surgery
36 National/International Pilot Sites Christus Health Texarcana, TX Horizon Health Network St. John, Canada Wake Forest Baptist Hospital Winston Salem, ND Rochester Regional Hospital Rochester NY
37 150 sites from WA state 4 national pilot sites 36 sites accessed the toolkit 40 additional sites nationally registering End of Year Projection: 230 sites implementing S4S
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39 Raising Awareness Changing Practice
40 Contact Susan Chishimba ACS NSQIP Business Development Representative American College of Surgeons 633 N. Saint Clair St. Chicago, IL Ph: Fax:
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47 Contact Susan Chishimba ACS NSQIP Business Development Representative American College of Surgeons 633 N. Saint Clair St. Chicago, IL Ph: Fax:
48 Thank
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