UF, Shands participate in national patient safety study focused on heart surgery

Gregory Janelle, M.D., chief of cardiovascular anesthesia in the UF College of Medicine’s department of anesthesiology

The University of Florida and Shands at UF medical center are part of a new $4 million, three-year national patient safety study aimed at reducing the rates of illness and premature death and lowering treatment costs for people who have heart surgery.

Funded by the Agency for Healthcare Research and Quality, the study is being conducted at 17 sites in 12 states and coordinated by the Quality and Safety Research Group at the Johns Hopkins School of Medicine and the Society of Cardiovascular Anesthesiologists Foundation. It will compare patient outcomes and rates of medical errors from a program that uses various measures to incorporate research-based evidence to clinical practice, enhance communication among health-care professionals at various levels and adjust procedures after mistakes have been made, with results from a different program based on simply reporting after-the-fact patient safety data.

“The cardiac surgical environment has evolved into a culture of safety, where concern for our patients has really broadened to include comprehensive outcomes for which we as a team bear shared responsibility,” said Gregory Janelle, M.D., chief of cardiovascular anesthesia in the UF College of Medicine’s department of anesthesiology, who leads the UF-based portion of the study. “We anticipate that this study will demonstrate improved outcomes in our patients, empowering cardiac surgical programs across the country to follow a new standard of enhanced communication and teamwork in order to reduce errors related to human factors.”

More than 50,000 patients annually suffer from adverse events after open heart surgery, according to estimates based on American Heart Association data. Half of those events are considered preventable.

The current study of how various safety measures can improve patient outcomes builds on previous work by the researchers to identify frequently occurring medical errors and develop communication and assessment tools that can be tailored for use by different institutions.

In particular, the researchers will examine whether the program reduces the occurrence of a number of key contributors to adverse outcomes in patients, namely, infections associated with surgical sites and central lines inserted into the bloodstream, as well as pneumonia associated with ventilator use.

They will also look into improving communication and reducing error at three crucial transition points in a patient’s care — when patients are handed from the operating room into the intensive care unit, when they are moved from the intensive care unit to the hospital floor, and when they are discharged from the hospital.

The team-based safety measures will engage not only attending surgeons and anesthesiologists, but fellows and residents in training, circulating nurses, ICU nurses, perfusionists, surgical and scrub technicians and everyone else involved in a patient’s care. The researchers will evaluate the program to see how it promotes an overall culture of safety in cardiac surgery intensive care units.

“For too long, efforts to improve safety have been independent, rather than interdependent; competitive, rather than cooperative; and focused on efforts rather than results,” said Peter Pronovost, M.D., Ph.D., director of the Quality and Safety Research Group, who heads the overall research effort. “In this project we will change this — working together guided by science and informed by practice we can reduce harm to patients.”