Improving adherence to a monitoring protocol for myocardial injury after non-cardiac surgery
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Improving adherence to a monitoring protocol for myocardial injury after non-cardiac surgery Amelie Pelland, MD, FRCPC . Anthony Chau, MD, FRCPC, MMSc . Hyun-Jung Shin, MD, PhD . Christopher Prabhakar, MD, FRCPC
Received: 2 May 2020 / Revised: 4 May 2020 / Accepted: 4 May 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, In 2016, the Canadian Cardiovascular Society (CCS) released clinical practice guidelines1 for the perioperative cardiovascular management of patients undergoing noncardiac surgery. These new guidelines represented a significant departure from other widely used guidelines2,3 in that biomarkers, specifically brain natriuretic peptide (BNP) or N-terminal-pro hormone BNP (NT-proBNP), were strongly recommended for both cardiac risk assessment and monitoring for myocardial injury after non-cardiac surgery (MINS). The Department of Anesthesia at St. Paul’s Hospital (SPH) in Vancouver, BC, a tertiary academic acute care hospital, was an early adopter of the CCS guidelines and implemented a local MINS protocol in January 2017. Successful implementation of the MINS protocol requires appropriate patient identification, followed by protocol activation and completion for all eligible cases throughout the entire perioperative course. One year following our MINS protocol implementation, we sought to determine the rate of adherence for protocol activation and completion at SPH. We aimed to determine the baseline adherence rates for elective and emergency
surgeries and hypothesized that the use of bundled interventions would improve adherence rates. The study was a quality improvement project and did not require institutional ethics approval. The preintervention phase was from 1 September to 30 November 2017 (at least six months following initial MINS protocol implementation, with three consecutive months of data collection that avoided the summer and winter holiday-related reductions in operating room scheduling). The bundled interventions that were introduced throughout March 2018 are listed in the Table. The post-intervention phase was from 1 April to 30 June 2018. All data were collected retrospectively by three anesthesiologists using the operating room administration records and the hospital’s digital charting system. The availability of preoperative NT-proBNP and appropriate ordering of postoperative troponins for eligible patients were used to define adherence to protocol activation and completion, respectively. Rates of adherence were compared using Fisher’s Exact test.
A. Pelland, MD, FRCPC (&) A. Chau, MD, FRCPC, MMSc C. Prabhakar, MD, FRCPC Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada e-mail: [email protected] Department of Anesthesia, St. Paul’s Hospital, Vancouver, BC, Canada H.-J. Shin, MD, PhD Department of Anesthesia, St. Paul’s Hospital, Vancouver, BC, Canada
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Pelland et al. Table Perioperative bundled interventions used to improve rates of adherence for MINS protocol activation and
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