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

NSQIP data—Deciles (1-10)

Importance of FEEDBACK

Questions??

Reduction in Postoperative Pulmonary Complications Ventilator Acquired Pneumonia (PACU and

CSICU). Establishing best practices.Use of EVAC endotracheal tubesPatients nursed 30 degree head up Mouth care

Aug 2012 Baseline Feb 2013 Post-ICOUGH

Cardiac Surgery “Time-Out” Between anesthesia and perfusion to

enable a more patient specific approach to CPB prime and volume replacementVolulyte, albumin, or crystalloid GFR <50

Size of circuit Ultra-filtration/dialysis Blood transfusion issues Cerebral oxygenation issues including

hemodynamic/hematocrit goals

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

Speakers

Dr Mitra Maharaj—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