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March Newsletter

March Newsletter

Written by Sherri White

March 14, 2021

Spring Quarterly Meeting Recap

On Thursday, March 11, 2021, approximately 50 members virtually gathered for the Spring Quarterly Meeting.  The evening provided updates on various initiatives and new endeavors within VCSQI.

 

Welcome and Highlights from the Board

Dr. Robert Shor welcomed members to the meeting and encouraged all to remain safe.

Financials continue to be stable.

Cath Film Reviews:

VCSQI launched a new initiative with Maryland Academic Consortium for Percutaneous Coronary Intervention Appropriateness and Quality (MACPAQ) for angio film reviews.  Currently, two centers are piloting the new effort.  Thereafter, there will be a staggered roll out to other VCSQI members. VCSQI is also exploring opportunities for ongoing collaborative efforts with MACPAQ and Johns Hopkins.

Aggregate Registries: STEMI w/VHAC and TVT Database:

We are closer to aggregating statewide STEMI data.  Currently, 5 centers are piloting this effort with Chest Pain MI (CP-MI) and Get With the Guidelines (GWTG) in collaboration with ARMUS.

TVT data specifications are expected by the end of the first quarter from ACC and NCDR.

AKI & Shock Workgroups:

Members were encouraged to complete active surveys in support of ongoing  initiatives.

Healthcare Disparities:

VCSQI strives to maintain the momentum in recognizing health care disparities not only as it relates to patient care but also in the structure of our organizations.  A new workgroup develop some of the initial questions and VCSQI will reach out to experts to help lead this effort.

Same Day Discharge:

This is an important effort and is taking time to review the current practices and data of member programs.  VCSQI strives to launch this effort within the second half of the year.

Committees, Workgroups and Partners

Please click on the tabs below to read about each update. 

Perfusion Group (PG)

Eve Dallas, CPP (UVA), Workgroup Champion, urged members to allow representation from each organization as a voice within the workgroup.  The following organizations are represented on the workgroup:

Carilion, Centra, HDH, Inova Fairfax, Mary Washington, Riverside, UVA, VCU, and Winchester

Please reach out to Sherri and/or Eddie info@vcsqi.org to join this workgroup.

Results of the AKI Perfusion survey has been favorable.  Currently, 7 member organizations have participated in the survey.

The next VCSQI-PG meeting will be March 16, 2021.  We are offering this meeting at two times to allow members to participate.  If you are interested in attending, please RSVP using the link below that best fits your schedule:

Noon Session –  https://us02web.zoom.us/meeting/register/tZMkd-2spz8iH9Md28newKKwSnII75V53lO2

5:30  PM Session –Https://us02web.zoom.us/meeting/register/tZYrfu6trzkvHNOmjjYOI4sCMLiqFMOWXjLA 

Other initiative of the workgroup includes EMR intergration (EPIC), Goal Directed Perfusion, and AKI in collaboration with the AKI Workgroup.

AKI Workgroup

Since the initial launch of the workgroup in December 2021, the group’s Champions, Mike Brown, CPP (Mary Washington), Chris Sytsma (Winchester) and Greg Dehmer, MD (Carilion)  quickly organized efforts to gather information regarding current AKI practices from the cardiology, surgical, and perfusion perspectives.

The Maryland Cardiac Surgery Quality Initiative (MCSQI) have also joined the effort and have participated in the AKI Perfusion services.

he group is actively reviewing VCSQI renal failure and AKI data to identify trends and explore opportunity for improvement as well as reviewing literature to remain abreast on current practices. COAP (Washington collaboration) has also joined this effort.

The group anticipates the release of the STS AKI Guidelines and will continue to explore best practices and assess current trends until then.
– Virginia Heart Attack Coalition

If you have not already completed the AKI surveys based on your respective specialty, please do so via the links below:

Surgery https://www.surveymonkey.com/r/AKISurg

Cardiology – https://www.surveymonkey.com/r/AKICard

Perfusion – https://www.surveymonkey.com/r/AKIPerf

If you or a member of your team are interested in participating in this workgroup, please let us know

Shock Workgroup

In collaboration with VHAC, the Shock Assessment was launched at the end of January.  Approximately 36 of 44 PCI Centers were invited to participate in the survey.  To date, 15 responses have been received.

VCSQI responses received from: VCU, Inova Health, Riverside, Carilion, Sentra Martha Jefferson, Sentara Williamsburg, Sentra Regional, Inova Heart & Vascular, Winchester, Sentara Halifax, Centra, and UVA.

Dr. O’Brien encouraged all members to participate in the survey. The goal of the survey is to get a first look at the state to assess current shock management practice patterns as this will help drive the development of best practices. To complete the Shock survey, please visit the link below: https://www.surveymonkey.com/r/VCSQIVHAC

 

Virginia Heart Attack Coalition (VHAC)

Dr. Pete O’Brien provided an update on efforts within VHAC.  Established in 2008, VHAC’s efforts has been dedicated to improving timeliness and access of care for Stemi across the state.  VHAC is honored to join VCSQI, with Dr. Tehrani (Inova) in developing the same goal within Shock across the state.

On March 3, Dr. Stephen Rennyson (Centra) and Dr. Benham Tehrani (Inova) gave a presentation at the VHAC Statewide meeting on cardiogenic shock that was well received.

VHAC is excited to reinstate and enhance the Stemi databases that includes CP-MI and GWTG.

VHAC is seeking members (administrators, EMS, cardiologists, nursing, etc.) help lead regional efforts in Stemi.

If you would like to get involved with VHAC please reach out to Pete O’Brien, MD at peter.obrien@centrahealth.com  or 434-942-9016. Website: www.virginiaheartattackcoaltion.org

 

Enhanced Recovery Taskforce

Enhanced Recovery Taskforce

In February 2020, Bethany Sarosick, RN, was announced as the Champion of the group.  Bethany functions as the ERAS Coordinator for the University of Virginia and serves on the American Society for Enhanced Recovery’s Nurse/ERAS Coordinator Committee.

Dr. Kevin Lobdell will server as the Strategic Advisor for the group.

The ERAS virtual meeting was recently held and VCSQI attended.  The committee is looking forward to working with Dr. Lobdell in learning new approaches and advantages through enhanced recovery.

Those interested in joining the workgroup, please feel free to contact Sherri and/or Eddie at info@vcsqi.org to express your interest.

 

Research & Writing

The Committee recently published 2 articles:

  1. Variability and Utilization of Concomitant Atrial Fibrillation Ablation During Mitral Valve Surgery.  Annals of Thoracic Surgery 111.1 (2021): 29-34.
  2. Burden of Tricuspid Regurgitation in Patients Undergoing Coronary Artery Bypass Grafting.  Annals of Thoracic Surgery 111.1 (2021): 44-50.

Four active projects are underway within the Committee which includes Afib Obesity with Amiodarone.

Did you know…

In 2006, the non-governmental organization, Madaktari Africa, began its efforts to improve health care and create medical autonomy in Tanzania, Africa, through the training and education of local medical personnel.   Peter O’Brien, MD, FACC, is named as one of the pioneers in this effort through his efforts of creating the first government ran Cath Lab in Tanzania. 

VCSQI recognizes Dr. O’Brien for all that he does in improving heart health thoughout the world. 

Perfect Care – VCSQI Collaboration

Dr. Lobdell gave an overview of resources and advantages of utilizing advanced technology within Perfect Care in partnership with Carium.  This includes clinical remote monitors to assess heart rate, steps, sleep, weight, in addition to technology to promote telehealth visits. 

Participants were also introduced to the new collaborative with VCSQI that extends access to summary data, best practices and more via the Collaborative Improvement Network (CIN).  Through this efforts VCSQI and Perfect Care will share summary-level data on clinical, financial metrics, best practices and more through ARMUS. 

 

On March 6, 2021, over 14,000 participants from approximately15 different countries joined virtually at the ERAS and COVID-19 Global Seminar.  The conference focused around using technology to better engage our patients and adding fields into the database to help capture key metrics to add.  The recording of prior ERAS conferences will be released at a later date. 

ACTIVE SURVEYS

AKI Workgroup: Perfusion Survey

https://www.surveymonkey.com/r/AKIPerf

AKI Pre-Assessment – Cardiology

https://www.surveymonkey.com/r/AKICard

AKI Pre-Assessment – Surgery

https://www.surveymonkey.com/r/AKISurg

Cardiac Ramifications of Covid

https://www.surveymonkey.com/r/BMHKJ85

VCSQI/VHAC Shock Management Survey

https://www.surveymonkey.com/r/VCSQIVHAC

 

CathPCI Reports and Quality Initiative Progress

Eddie Fonner (VCSQI, Executive Director) provided an extensive update on the revamped effort on angiogram film reviews in partnership with Maryland Academic Consortium for Percutaneous Coronary Intervention Appropriateness and Quality (MACPAQ).  Participating organizations will be provided with a secure gateway to upload data.  Films will be reviewed and returned to VCSQI.  Individual and aggregate level data will be shared within VCSQI.  Two member organizations are currently piloting this new process.  Additional member programs will be invited to participate in this review process on a staggered bases.  Participating members will not incur any additional costs for joining.

The objective of the VHAC/VCSQI Statewide STEMI Database was demonstrated with a schematic of the upload process and overview of initial report metrics.  No additional costs will be incurred by member organizations.  If you are interested in participating and helping to pilot this project, please contact us at info@vcsqi.org.

The latest CathPCI metrics (Q4 2019 – Q3 2020) were reviewed in detail including statewide procedure volume.  The follow metrics were discussed:

  • Vascular Access Site by Hospital: PCI without CABG
  • Avg. Predicted Risk of Mortality by Hospital: PCI without CABG
  • Observed Bleeding by Hospital: PCI without CABG
  • RBC/Whole Blood Transfusion by Hospital: PCI without CABG
  • Death, Emergency CABG, Stroke, or RTVR by Hospital: All PCIs
  • Fluoro Time > 60 Minutes by Hospital: PCI without CABG
  • Average Length of Stay (Days): PCI without CABG
  • Observed AKI Rate by Hospital: PCI without CABG
  • Observed AKI Rate by Hospital: PCI without CABG
  • Discharge Time by Hospital: Elective PCI
  • Discharge Time by Hospital and Access Site: Elective PCI

Comparing the data against practice changes relative to AKI and creatinine rates will be evaluated and presented at a future meeting.

Obesity as a Pharmacokinetic Factor in Response to Amiodarone

Chris Systma (Winchester) gave a compelling presentation on associated risk factors of obesity in response to Amiodarone that included a review of Amiodarone guidelines and past advances.

 

Machine Learning and Clinical-Financial Reporting Updates

Gyula Sziraczky, President, ARMUS Corporation provided an update on efforts in utilizing Machine Learning to predict outcomes in cardiac services.  They have tested various data models and approached to move this initiative forward.

ARMUS has consolidated data to assess A-fib metrics and determine which factors impact cost of care.  Members of VCSQI were encouraged to participate on the Data Review Taskforce to help develop the application and model for VCSQI.

Please contact VCSQI at info@vcsqi.org to express your interest in joining the group.

A presentation/video has been prepared to for members to assess and better understand the distribution of cost relative to cardiac care.

To access the site, visit

https://www.armus.com/vcsqi-video

Login information will be sent to each member site and can be obtained by contacting Eddie or Sherri at info@vcsqi.org.

 

Does VCSQI add value to the work you do within your organization?

If so, we would like to know.  Please take a moment to provide your feedback via the link below.

ASER 2021 Annual Congress of Enhanced Recovery and Perioperative Medicine - April 7-9, 2021

The American Society for Enhanced Recovery (ASER) will hold its 9th annual spring meeting dedicated to Enhanced Recovery and Perioperative Medicine issues. This three-day program includes exciting multidisciplinary interactive sessions, discussing key principles and the latest advances in Enhanced Recovery and Perioperative Medicine. Presentations will specifically explain ways to implement these new ideas in your hospital to improve outcomes.

ASER 2021 registrants may participate in the scheduled live discussion sessions as well as access on-demand meeting content.

Bethany Sarosiek, RN, MSN, MPH, CNL (VCSQI Enhanced Recovery Champion) service as a program chair during this meeting.

Registration is free.  Visit ASERHQ.org/2021 for more info.

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