28. Patient Reported Outcomes for Quality Improvement and Enhanced Patient Safety in Cardiac Surgery: A Multi-Center Collaborative Project
*Louis P. Perrault1, Emilie Escaffre1, Anne Nguyen1, Daniel T. Engelman2, Cheryl Crisafi2, Gregory Mishkel3, Neil J. Thomas3, Amy Durako3
1Montreal Heart Institute, Montreal, QC, Canada;2Baystate Medical Center, Springfield, MA;3Prairie Cardiovascular, Springfield, IL
Invited Discussant: *Tom C. Nguyen
Objective: Patient-reported outcomes (PROs) are increasingly being recognized as an important measure of quality. However, PROs in surgery are typically limited to parts of the perioperative setting (e.g. post-discharge only) and used in isolation (e.g. single-site). To the best of our knowledge, we conducted the first reported project in Cardiac Surgery to (i) use patient-centered, mobile and web-based technology to collect standardized PROs across the entire perioperative continuum at 3 cardiac surgery centers; (ii) use dashboards to benchmark PROs among the 3 centers to identify quality improvement opportunities; and (iii) leverage the data to engage cardiac surgeons and nurses at all 3 sites to identify high performers, share best practices and make continuous improvements to their cardiac care pathways.
Methods: Identical patient engagement technology was implemented at three major cardiac surgery centers to provide patients with a best-practice pathway and collect PROs. Patients accessed the program on smartphones, tablets or computers, and were provided with reminders, education and PRO surveys pre-op, in-hospital and for the first 30 days post-discharge. PRO surveys measured compliance with the ERAS protocol (e.g. pre-op chlorhexidine wash, post-op mobilization, etc.) and post-op functional status (e.g. pain, anxiety, blood pressure, heart rate, etc.). The aggregate PRO data collected on the platform was exported for further analysis, including comparative analysis between all 3 sites.
Results: Between April 2017 and January 2019, 2,174 cardiac surgery patients were enrolled in the patient engagement technology program and 1,554 completed their full pathway. 73% (1,134/1,554) of patients activated their accounts on the technology platform and completed a total of 8,641 PRO surveys. Comparative analysis and benchmarking between the 3 sites identified variability in 3 key PRO measures (active pain, resting pain and anxiety), with certain sites having stronger results than others for each measure. For example, the average cardiac center pain score on POD 1 was 2.6/10, ranging from 1.6 at the lowest scoring cardiac center to 3.3 at the highest scoring cardiac center (a variation of over 100%). In addition, the cardiac program with the lowest average pain score on POD 1 (1.6/10) also had the lowest average blood pressure and heart rate throughout the 30-day recovery period. Recognition of this type of variability has resulted in monthly meetings between care teams at the 3 sites to compare performance and share best practices on topics such as pain management, early mobilization, and sleep quality.
Conclusions: Multi-site PRO data collection, benchmarking and collaborative quality improvement meetings in Cardiac Surgery are an effective means to improve surgical quality and patient safety by sharing best practices. Future projects will include further analyses on the impact of measures to improve PRO-driven quality indices on clinical outcomes.