Talk Description
Objectives:
This audit aims to compare the efficiency of ICU care of post-operative cardiac surgery patients at a traditional hospital to the newly opened Victorian Heart Hospital (VHH) and provide a benchmark for future evaluation of operational and care efficiency at VHH.
This audit aims to compare the efficiency of ICU care of post-operative cardiac surgery patients at a traditional hospital to the newly opened Victorian Heart Hospital (VHH) and provide a benchmark for future evaluation of operational and care efficiency at VHH.
Methods:
We conducted a retrospective audit of 100 cardiac surgery patients admitted to ICU at Monash Medical Centre (MMC) (n=50), and the VHH (n=50) between November 2022 and May 2023. Low risk ethics application was approved from the Monash Health Research Office (ERM reference number: 101298). Deidentified data including factors relating to cost and patient flow was extracted from electronic medical records and findings aggregated into medians.
We conducted a retrospective audit of 100 cardiac surgery patients admitted to ICU at Monash Medical Centre (MMC) (n=50), and the VHH (n=50) between November 2022 and May 2023. Low risk ethics application was approved from the Monash Health Research Office (ERM reference number: 101298). Deidentified data including factors relating to cost and patient flow was extracted from electronic medical records and findings aggregated into medians.
Results:
Demographics between the two ICU cohorts were similar across age, gender, APACHE 2 score, type and urgency of surgery and admission time. The patients at VHH ICU had a shorter median ICU Length of stay (LOS) than MMC ICU (27hrs vs 45hrs). The median LOS for the patients admitted after hours was similar at both sites (48hrs) despite of higher numbers of aortic surgery patients admitted after hours at VHH vs MMC (24% to 0%). The median time to extubation following ICU admission was lower for patients admitted at VHH vs MMC (7hrs vs 10hrs), with a higher of percentage of patients being extubated within 6hrs at VHH vs MMC (38% vs 20%). The median duration of vasoactive use following ICU admission was lower VHH vs MMC (16hrs vs 19.5hrs). More patients at VHH were normothermic (temperature >36 C) on arrival to ICU than at MMC (68% vs 46%) and the median time to achieve normothermia at VHH was faster for those with admission temperatures <36 C (2.5hrs vs 3.6hrs). Approximately one third of patients at both sites did not have documentation of peri-extubation pain scores. The incidence of uncontrolled pain within the first 24hrs of ICU admission, defined as ≥2 scores of moderate or severe pain, was higher at VHH vs MMC (64% vs 36%).
Demographics between the two ICU cohorts were similar across age, gender, APACHE 2 score, type and urgency of surgery and admission time. The patients at VHH ICU had a shorter median ICU Length of stay (LOS) than MMC ICU (27hrs vs 45hrs). The median LOS for the patients admitted after hours was similar at both sites (48hrs) despite of higher numbers of aortic surgery patients admitted after hours at VHH vs MMC (24% to 0%). The median time to extubation following ICU admission was lower for patients admitted at VHH vs MMC (7hrs vs 10hrs), with a higher of percentage of patients being extubated within 6hrs at VHH vs MMC (38% vs 20%). The median duration of vasoactive use following ICU admission was lower VHH vs MMC (16hrs vs 19.5hrs). More patients at VHH were normothermic (temperature >36 C) on arrival to ICU than at MMC (68% vs 46%) and the median time to achieve normothermia at VHH was faster for those with admission temperatures <36 C (2.5hrs vs 3.6hrs). Approximately one third of patients at both sites did not have documentation of peri-extubation pain scores. The incidence of uncontrolled pain within the first 24hrs of ICU admission, defined as ≥2 scores of moderate or severe pain, was higher at VHH vs MMC (64% vs 36%).
Discussion:
This audit indicated that a dedicated cardiac hospital was associated with improved efficiency of intensive care following cardiac surgery, compared to a similar cohort of patients at a traditional tertiary centre. This was true in all key metrics, except for pain monitoring and management, representing an area for improvement. A larger audit is needed to evaluate operational efficiency and monitor compliance to high standard of care as workload increases at the Victorian Heart Hospital in upcoming months.
This audit indicated that a dedicated cardiac hospital was associated with improved efficiency of intensive care following cardiac surgery, compared to a similar cohort of patients at a traditional tertiary centre. This was true in all key metrics, except for pain monitoring and management, representing an area for improvement. A larger audit is needed to evaluate operational efficiency and monitor compliance to high standard of care as workload increases at the Victorian Heart Hospital in upcoming months.
Conflicts of Interest:
none
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