RITE Cohort: RITE 24 Thursdays Summer 2022
Team Members: Adam M. Andruska, MD, MSE; Hailey Kopps, PT, DPT, Maria Currie, MD PhD; Nanette A Hinojales, RN; Elizabeth Crowder PA-C, AACC; Marcy Sears, RN.
Team Sponsor(s): David Svec, MD, MPH; Meghan Ramsey, MD
The Problem: Cardiothoracic surgery (CTS) patients require highly coordinated care by numerous services in the intensive care unit (ICU) after surgery. Complications in this time period increase morbidity, are costly, and significantly increase time spent in the ICU. We set out to shorten the time between cardiothoracic surgery and the patient ambulating with physical therapy as a marker for appropriate patient progress. Delays in time to ambulation after surgery reflect both patient complications and systems issues preventing progression. Our goal was to improve the percentage of patients ambulating on postoperative day one from 60% to greater than 70%.
Our analysis pointed to several key focus areas from our fishbone:
We were able to achieve our SMART goal and increased the percentage of patients meeting post-operative day one ambulation goals to 80%, potentially freeing up to 16 ICU days per month. This projects also had institutional impacts that include the following:
- Order set improved autonomy efficient planning of the day
- Delirium prevention, cohesive care, confidence and return to function for the patient
- Once ambulating, patients can often be downgraded from ICU status, freeing ICU beds and decreasing costs over the length of stay.
Throughout this cohort we learned a lot! First, it’s critical to establish a reliable source of data early in the project. Data collection through automated means (e.g., auto population, EDGE reporting through EPIC) not only make the project work go smoothly but enable a way to monitor outcomes going forward. Second, establishing roles amongst the team was very important to our success. Specifically having a “Data Champion” to oversee quality and timely data collection is crucial. Third, Clinician and Surgeon schedules can be challenging to work around. We found it was critical to establish norms early. Fourth, it was very important to have team members who were directly involved in the process (PT, RN). This allowed our team to identify barriers and develop interventions that have buy in from all stakeholders. And finally, we uncovered several patient subgroups during our project. These required different interventions and our team had to pivot accordingly.