A system-wide extracorporeal membrane oxygenation quality collaborative improves patient outcomes
| Autor: | Alessandro Lione, Nancy Vish, Jenelle Sheasby, Aayla K. Jamil, Mary Beth Zimmerman, Eleanor A. Huff, Timothy J. George, Gonzalo V. Gonzalez-Stawinski, Allison Archibald, Gary S. Schwartz, Michael J. Mack, Julius C. Wicke, Scott Noesges, Dan M. Meyer, Johanna S. van Zyl, Jorge F. Velazco, Laila Mallari, Omar Hernandez, Chris Martin, Briget da Graca, Joost Felius |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty medicine.medical_treatment 030204 cardiovascular system & hematology Rate ratio law.invention 03 medical and health sciences 0302 clinical medicine Extracorporeal Membrane Oxygenation law Health care Outcome Assessment Health Care Extracorporeal membrane oxygenation Medicine Humans Extracorporeal cardiopulmonary resuscitation Hospital Mortality Cooperative Behavior Aged business.industry Delivery of Health Care Integrated Hazard ratio Middle Aged Intensive care unit Quality Improvement Survival Analysis Texas Confidence interval surgical procedures operative 030228 respiratory system Emergency medicine Practice Guidelines as Topic Surgery Female Cardiology and Cardiovascular Medicine business Complication |
| Zdroj: | The Journal of thoracic and cardiovascular surgery. 163(4) |
| ISSN: | 1097-685X |
| Popis: | Objective Extracorporeal membrane oxygenation (ECMO) use in adult patient populations has grown rapidly with wide variation in practices and outcomes. We evaluated the impact on patient outcomes, resource use, and costs of an initiative to coordinate and standardize best practices across ECMO programs within a large integrated health care system. Methods The ECMO Collaborative Project brought clinicians and service-line leaders from 4 programs within a single health care system together with operational subject matter experts tasked with developing and implementing standardized guidelines, order sets, and an internal database to support an automated quarterly report card. Patient outcomes, resource use, and financial measures were compared for the 16 months before (January 2017 to April 2018; “precollaborative,” n = 185) versus the 14 months after (November 2018 to December 2019, “postcollaborative,” n = 243) a 6-month implementation and blanking period. Subset analyses were performed for venoarterial ECMO, venovenous ECMO, and extracorporeal cardiopulmonary resuscitation. Results Survival to discharge/transfer increased significantly (in-hospital mortality hazard ratio, 0.75; 95% confidence interval [95% CI], 0.58-0.99) for the postcollaborative versus the precollaborative period (107/185, 57.8% vs 113/243, 46.5%, P = .03), predominantly due to improvement among patients receiving venoarterial ECMO (hazard ratio, 0.61; 95% CI, 0.41-0.91). The percentage of patients successfully weaned from ECMO increased from 58.9% (109/185) to 70% (170/243), P = .02. Complication rates decreased by 40% (incidence rate ratio, 0.60; 95% CI, 0.49-0.72). No significant changes were observed in ECMO duration, intensive care unit or hospital length of stay, or cost-per-case; payment-per-case and contribution-margin-per-case both decreased significantly. Conclusions The ECMO Collaborative Project improved survival to discharge/transfer, weaning rates and complications, without additional costs, through coordination and standardization across ECMO programs within a health care system. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|