Quality and Value Are Crucial for CT ICUs

Kevin W. Lobdell, MD

To say that Kevin W. Lobdell, MD has a patient-centered approach is an understatement. As Director of Quality for the Sanger Heart & Vascular Institute at Carolinas HealthCare System in Charlotte, N.C., he and his team rely on quality measures to make comprehensive performance management improvements in cardiothoracic critical care.

“Let’s agree that much has been organized around health care workers, as opposed to our patients. It never occurred to me that care wouldn’t be patient-centered. I kind of coined the term PCTR—patient-centered transformational redesign—in our work here. We’re looking to do things that will transform the quality and value of medicine, and inherent in all of that is a redesign,” said Dr. Lobdell, who is a co-moderator of the STS/AATS Critical Care Symposium: Quality and Value in the CT ICU, which will be held from 7:50 a.m. to 12:00 p.m. on Sunday, January 24.

The session will focus on the role of postoperative quality and value improvement initiatives in reducing morbidity and mortality, as well as leveraging expertise with telehealth solutions, hospital-acquired infections (HAIs), mechanical ventilation, and advanced life support.

“We broke the session down by phases of care and things that we could do to assess and mitigate risk. Then we went by body systems, so we looked at it from different directions,” said Dr. Lobdell, Clinical Professor of Surgery at the University of North Carolina-Chapel Hill. “We even looked at registration data and feedback to make sure that our offering not only was current and respectful of what’s been done in the past, but also one that would allow us to improve on how we present these topics.”

A member of both the STS Workforce on Critical Care and Workforce on Patient Safety, he will begin the program by describing the principles and potential impact—both positive and negative—of quality and value. This will flow into a discussion on the use of the tele-ICU to transform critical care. Formal ICU telemedicine programs now support 11% of non-federal hospitalized critically ill adult patients, according to a November 2014 article in Critical Care Medicine.

“We’ll emphasize how tele-ICUs improve the quality of care and have a financial impact,” Dr. Lobdell said.

In addition to a presentation on the effect of HAIs on quality and value, attendees will learn about the Hospital Microbiome, which aims to collect microbial samples from surfaces, air, staff, and patients at The University of Chicago’s new Center for Care and Discovery.

“This cutting-edge work will provide a comprehensive view of the hospital environment, its practices, and how that system either fosters or prevents infections,” Dr. Lobdell said.

After an overview of cardiac surgery unit-advanced life support (CSU-ALS), speakers will describe the role of physician assistants and implementation in a CT ICU. In use in Europe, CSU-ALS is a set of protocols for patients suffering cardiac arrest and all common serious complications in an ICU or on a cardiac surgery unit. (See related article.)

The session will conclude with four presentations about prolonged ventilation.

“We track five major complications: stroke, reoperation, prolonged ventilation, deep sternal infection, and acute renal failure,” Dr. Lobdell said. “We thought that given the impact of prolonged ventilation on the quality and the value of our efforts, it was worth spending a section of this session on this topic.”

Speakers will share expertise on the ventilator bundle, prevention of prolonged ventilation, timing of tracheostomy, and extracorporeal membrane oxygenation.

Dr. Lobdell encouraged those who have roles in the evolving multidisciplinary cardiothoracic critical care team to attend the Critical Care Symposium, noting that they will leave with important information on quality and value.