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Category Archives: Protocols

Virginia Cardiac Surgery Quality Initiative’s Multi-Center Red Blood Cell Transfusion Study

Cardiac surgery accounts for 20% of blood transfused within the United States.(1) Today 30-65% of patients undergoing cardiac surgery receive a blood transfusion (2-3) and often receive more than one unit. The risk of virus transmission from transfusion is radically decreased since the 1990’s therefore the focus upon transfusion risks is shifting.  Red cell function (ability to carry and release oxygen), immune modulation, transfusion related acute lung injury, cytokine generation, allergic reaction and ABO incompatibility have become the risks of transfusion.(4-8)   Today an emerging literature is noting that blood transfusions are associated with worse outcome, longer hospital and ICU stays, decreased post-operative quality of life and even increased mortality after heart surgery out to 60 months. (4-9) 


VCSQI Readmissions Reduction Protocol

CMS currently estimates that avoidable hospital readmissions account at $17.4 billion, or 17% of the $102.6 billion Medicare budget. The Median number of patients readmitted after CABG from the STS national database is 10%. VCSQI data on readmissions after CABG (2002-2014) ranges from 7.1% to 9.1%. Beginning in 2017, CMS will reduce payments to hospitals with excessive readmissions after CABG surgery. Hospitals that have implemented some form of readmission reduction programs were able to reduce readmission by 10 to 30%.


Atrial Fibrillation Prophylaxis Protocol

The purpose of this quality improvement initiative is to lower the incidence of complications among patients undergoing a CABG or valve repair/replacement surgery in VCSQI member heart centers.  We hope to demonstrate that by lowering the incidence of post-operative atrial fibrillation, hospital costs and resources used will be contained while clinical processes are improved.  We hope to improve clinical quality through sharing information and collaborating in the analysis of outcomes data.