Daniel I McIsaac1,2, Joshua Montroy2,3, Sylvain Gagne1, Chris Johnson4, Jacelyn Ernst4, Samantha Halman5, Jeffrey Oake6, James Chan5, Susan Madden1, Simon Feng1, Michelle Moody1, Cedric Godbout Simard1, Monica Taljaard2,7, Madison Foster2,3, Dean A Fergusson2,3,7, Manoj M Lalu8,9,10,11,12. 1. Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada. 2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 3. BLUEPRINT Translational Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. 4. Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada. 5. Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada. 6. Department of Surgery, Division of Urology, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada. 7. School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada. 8. Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada. mlalu@toh.ca. 9. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. mlalu@toh.ca. 10. BLUEPRINT Translational Research Group, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada. mlalu@toh.ca. 11. Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada. mlalu@toh.ca. 12. Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Room B307, 1053 Carling Ave, Mail Stop 249, Ottawa, ON, K1Y 4E9, Canada. mlalu@toh.ca.
Abstract
PURPOSE: The Canadian Cardiovascular Society (CCS) guidelines for patients undergoing non-cardiac surgery address the lack of standardized management for patients at risk of perioperative cardiovascular complications. Our interdisciplinary group evaluated the implementation of these guidelines. METHODS: We used an interrupted time series design to evaluate the effect of implementation of the CCS guidelines, using routinely collected hospital data. The study population consisted of elective, non-cardiac surgery patients who were: i) inpatients following surgery and ii) age ≥ 65 or age 45-64 yr with a Revised Cardiac Risk Index ≥ 1. Outcomes included adherence to troponin I (TnI) monitoring (primary) and adherence to appropriate consultant care for patients with elevated TnI (secondary). Exploratory outcomes included cost measures and clinical outcomes such as length of stay. RESULTS: We included 1,421 patients (706 pre- and 715 post-implementation). We observed a 67% absolute increase (95% confidence interval, 55 to 80; P < 0.001) in adherence to TnI testing following the implementation of the guidelines. In patients who had elevated TnI following guideline implementation (n = 64), the majority (85%) received appropriate follow-up care in the form of a general medicine or cardiology consult, all received at least one electrocardiogram, and half received at least one advanced cardiac test (e.g., cardiac perfusion scan, or percutaneous intervention). CONCLUSIONS: Our study showed the ability to implement and adhere to the CCS guidelines. Large-scale multicentre evaluations of CCS guideline implementation are needed to gain a better understanding of potential effects on clinically relevant outcomes.
PURPOSE: The Canadian Cardiovascular Society (CCS) guidelines for patients undergoing non-cardiac surgery address the lack of standardized management for patients at risk of perioperative cardiovascular complications. Our interdisciplinary group evaluated the implementation of these guidelines. METHODS: We used an interrupted time series design to evaluate the effect of implementation of the CCS guidelines, using routinely collected hospital data. The study population consisted of elective, non-cardiac surgery patients who were: i) inpatients following surgery and ii) age ≥ 65 or age 45-64 yr with a Revised Cardiac Risk Index ≥ 1. Outcomes included adherence to troponin I (TnI) monitoring (primary) and adherence to appropriate consultant care for patients with elevated TnI (secondary). Exploratory outcomes included cost measures and clinical outcomes such as length of stay. RESULTS: We included 1,421 patients (706 pre- and 715 post-implementation). We observed a 67% absolute increase (95% confidence interval, 55 to 80; P < 0.001) in adherence to TnI testing following the implementation of the guidelines. In patients who had elevated TnI following guideline implementation (n = 64), the majority (85%) received appropriate follow-up care in the form of a general medicine or cardiology consult, all received at least one electrocardiogram, and half received at least one advanced cardiac test (e.g., cardiac perfusion scan, or percutaneous intervention). CONCLUSIONS: Our study showed the ability to implement and adhere to the CCS guidelines. Large-scale multicentre evaluations of CCS guideline implementation are needed to gain a better understanding of potential effects on clinically relevant outcomes.
Authors: Lee A Fleisher; Kirsten E Fleischmann; Andrew D Auerbach; Susan A Barnason; Joshua A Beckman; Biykem Bozkurt; Victor G Davila-Roman; Marie D Gerhard-Herman; Thomas A Holly; Garvan C Kane; Joseph E Marine; M Timothy Nelson; Crystal C Spencer; Annemarie Thompson; Henry H Ting; Barry F Uretsky; Duminda N Wijeysundera Journal: Circulation Date: 2014-08-01 Impact factor: 29.690
Authors: Linda Richter-Sundberg; Therese Kardakis; Lars Weinehall; Rickard Garvare; Monica E Nyström Journal: BMC Health Serv Res Date: 2015-01-22 Impact factor: 2.655