Advancing cardiotomy suction practices for coronary surgery via multidisciplinary collaborative learningCentral MessagePerspective
James W. Stewart, II, MD, MSc,
Donald Nieter, MHSA, DVM, CCP-Emeritus,
Xiaoting Wu, PhD,
Alphonse DeLucia, III, MD,
Brittney N. Graebner, CCP,
Gaetano Paone, MD, MHSA,
David C. Fitzgerald, DHA, MPH, CCP,
Timothy A. Dickinson, MS, CCP,
Min Zhang, PhD,
Francis D. Pagani, MD, PhD,
Donald S. Likosky, PhD
Affiliations
James W. Stewart, II, MD, MSc
Department of Surgery, Yale School of Medicine, New Haven, Conn; Department of Surgery, University of Michigan, Ann Arbor, Mich
Donald Nieter, MHSA, DVM, CCP-Emeritus
Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich
Xiaoting Wu, PhD
Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Mich
Alphonse DeLucia, III, MD
Department of Cardiac Surgery, Bronson Methodist Hospital, Kalamazoo, Mich
Brittney N. Graebner, CCP
Perfusion Associates of Michigan, Saginaw, Mich
Gaetano Paone, MD, MHSA
Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
David C. Fitzgerald, DHA, MPH, CCP
Cardiovascular Perfusion Program, College of Health Professions, Medical University of South Carolina, Charleston, SC
Timothy A. Dickinson, MS, CCP
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
Min Zhang, PhD
Department of Biostatistics, University of Michigan, Ann Arbor, Mich
Francis D. Pagani, MD, PhD
Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich; Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Mich
Donald S. Likosky, PhD
Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Mich; Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Mich; Address for reprints: Donald S. Likosky, PhD, Department of Cardiac Surgery, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109.
Objective: Professional standards recommend stopping cardiotomy suction at the termination of cardiopulmonary bypass before protamine administration based on perceived safety concerns. This study evaluated a multidisciplinary collaborative quality-improvement intervention promoting this agreed-upon cardiotomy suction practice during coronary artery bypass grafting (CABG). Methods: A statewide intervention (eg, unblinded surgeon and perfusionist feedback, evidence-based lectures, evaluating barriers to change) involved 32 centers participating in the PERForm (ie, Perfusion Measures and Outcomes) Registry to standardize cardiotomy suction practices at cardiopulmonary bypass termination during CABG. Four non-Michigan registry participating centers were not exposed to collaborative learning. Cardiotomy suction practice was defined as the absence of or stopping cardiotomy suction before protamine administration. The practice changes attributed to the intervention, including Michigan and non-Michigan comparisons, were evaluated with the change of time effect modeled using splines. Multivariable regression was used to evaluate the intervention's associated impact (eg, mortality, reoperation, transfusion). Results: Among 10,394 patients undergoing CABG at Michigan centers, 80.7% achieved agreed-upon cardiotomy suction practices. The Michigan centers had nonsignificant changes in agreed-upon cardiotomy suction practices during the preintervention period (P = .24), with significant increased monthly change in practice thereafter, absent adjusted morbidity and mortality increases. The Michigan centers achieved a significantly greater adjusted monthly improvement in agreed-upon practices relative to non-Michigan centers within 7 months after the intervention (adjusted odds ratio for change of trends: 2.53, P < .001). Conclusions: This initiative demonstrates the effectiveness of multidisciplinary collaborative quality improvement in advancing agreed-upon cardiotomy suction practices without negatively impacting clinical outcomes.
