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Patrick S Romano - One of the best experts on this subject based on the ideXlab platform.
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postoperative respiratory failure an update on the validity of the agency for Healthcare Research and quality patient safety indicator 11 in an era of clinical documentation improvement programs
American Journal of Surgery, 2020Co-Authors: Jacqueline Stocking, Garth H Utter, Christiana Drake, Matthew J Aldrich, Alpesh Amin, Rebecca A Marmor, Laura N Godat, Maxime Cannesson, Michael A Gropper, Patrick S RomanoAbstract:Abstract Background Administrative data can be used to identify cases of postoperative respiratory failure (PRF). We aimed to determine if recent changes to the Agency for Healthcare Research and Quality Patient Safety Indicator 11 (PSI 11) and adoption of clinical documentation improvement programs have improved the validity of PSI 11. We also analyzed reasons why PSI 11 was falsely triggered. Study design Cross-sectional study of all eligible discharges using health record data from five academic medical centers between October 1, 2012 and September 30, 2015. Results Of 437 flagged records, 434 (99.3%) were accurately coded and 414 (94.7%) represented true clinical PRF. None of the false positive records involved respiratory failure present on admission. Most (78.3%) false positive records required airway protection but did not have respiratory failure. Conclusion The validity of PSI 11 has improved with recent changes to the code criterion and adoption of clinical documentation improvement programs.
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development and validation of an agency for Healthcare Research and quality indicator for mortality after congenital heart surgery harmonized with risk adjustment for congenital heart surgery rachs 1 methodology
Journal of the American Heart Association, 2016Co-Authors: Kathy J Jenkins, Patrick S Romano, Jeffrey J Geppert, Jennifer Koch Kupiec, Pamela L Owens, Kimberlee GauvreauAbstract:Background The National Quality Forum previously approved a quality indicator for mortality after congenital heart surgery developed by the Agency for Healthcare Research and Quality (AHRQ). Several parameters of the validated Risk Adjustment for Congenital Heart Surgery (RACHS‐1) method were included, but others differed. As part of the National Quality Forum endorsement maintenance process, developers were asked to harmonize the 2 methodologies. Methods and Results Parameters that were identical between the 2 methods were retained. AHRQ's Healthcare Cost and Utilization Project State Inpatient Databases (SID) 2008 were used to select optimal parameters where differences existed, with a goal to maximize model performance and face validity. Inclusion criteria were not changed and included all discharges for patients <18 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for congenital heart surgery or nonspecific heart surgery combined with congenital heart disease diagnosis codes. The final model includes procedure risk group, age (0–28 days, 29–90 days, 91–364 days, 1–17 years), low birth weight (500–2499 g), other congenital anomalies (Clinical Classifications Software 217, except for 758.xx), multiple procedures, and transfer‐in status. Among 17 945 eligible cases in the SID 2008, the c statistic for model performance was 0.82. In the SID 2013 validation data set, the c statistic was 0.82. Risk‐adjusted mortality rates by center ranged from 0.9% to 4.1% (5th–95th percentile). Conclusions Congenital heart surgery programs can now obtain national benchmarking reports by applying AHRQ Quality Indicator software to hospital administrative data, based on the harmonized RACHS‐1 method, with high discrimination and face validity.
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improved coding of postoperative deep vein thrombosis and pulmonary embolism in administrative data ahrq patient safety indicator 12 after introduction of new icd 9 cm diagnosis codes
Medical Care, 2015Co-Authors: Banafsheh Sadeghi, Patricia A Zrelak, Richard H White, Gregory A Maynard, Amy Strater, Laurie Hensley, Julie Cerese, Patrick S RomanoAbstract:Background:Symptomatic venous thromboembolism is a common postoperative complication. The Agency for Healthcare Research and Quality (AHRQ) has developed a Patient Safety Indicator 12 to assist hospitals, payers, and other stakeholders to identify patients who experienced this complication.Objective
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using the agency for Healthcare Research and quality patient safety indicators for targeting nursing quality improvement
Journal of Nursing Care Quality, 2012Co-Authors: Patricia A Zrelak, Banafsheh Sadeghi, Garth H Utter, Ruth Baron, Joanne Cuny, Patrick S RomanoAbstract:Quantifying the critical impact nurses have on the prevention and early recognition of potential complications and adverse events, such as those identified by the Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSI), is becoming increasingly important. In this paper, we describe how the AHRQ PSI may be used to identify nursing-specific opportunities to improve care based on data from the national AHRQ PSI validation pilot project.
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positive predictive value of the agency for Healthcare Research and quality patient safety indicator for central line related bloodstream infection selected infections due to medical care
Journal for Healthcare Quality, 2011Co-Authors: Patricia A Zrelak, Banafsheh Sadeghi, Daniel J Tancredi, Garth H Utter, Ruth Baron, Jeffrey J Geppert, Patrick S RomanoAbstract:Abstract: As part of the Agency for Healthcare Research and Quality Patient Safety Indicator (PSI) Validation Pilot Project, we evaluated the criterion validity of PSI 7. At the time of this study, PSI 7 was entitled “Selected Infections Due to Medical Care” and targeted catheter-related infections and inflammatory reactions. We conducted a retrospective cross-sectional study of 23 volunteer U.S. hospitals, where trained abstractors reviewed a sample of records that met PSI 7 criteria from October 1, 2005 to March 31, 2007. Of the 191 cases that met PSI 7 criteria, 104 (positive predictive value = 54%, 95% confidence interval: 40–69%) represented true infections. Of these cases, 77 (74%) were associated with central venous catheters, 15 (15%) were associated with peripheral intravenous (n=13) and or or arterial catheters (n=6), and 12 (11%) were associated with unknown catheters. Of the 87 (46%) false-positive cases, 41 (47%) did not have a qualifying infection identified by the abstractor, 38 (44%) had an infection present on admission, and 8 (9%) had an exclusionary diagnosis. PSI 7 has a low positive predictive value compared with other PSIs recently studied. Present on admission diagnoses and improved coding for infections related to central venous catheters (implemented October 2007) may improve validity.
Amy K Rosen - One of the best experts on this subject based on the ideXlab platform.
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comparison of risk standardized readmission rates of surgical patients at safety net and non safety net hospitals using agency for Healthcare Research and quality and american hospital association data
JAMA Surgery, 2019Co-Authors: Stephanie D Talutis, Amy K Rosen, Qi Chen, Na WangAbstract:Importance Medical patients discharged from safety-net hospitals (SNHs) experience higher readmission rates compared with those discharged from non-SNHs. However, little is known about whether this association persists for surgical patients. Objectives To examine differences in readmission rates between SNHs and non-SNHs among surgical patients after discharge and determine whether hospital characteristics might account for some of the variation. Design, Setting, and Participants This observational retrospective study linked the Healthcare Cost and Utilization Project State Inpatient Databases of the Agency for Healthcare Research and Quality from January 1, 2011, through December 31, 2014, for 4 states (New York, Florida, Iowa, and Washington) with data from the 2014 American Hospital Association annual survey. After identifying surgical discharges, SNHs were defined as those with the top quartile of inpatient stays paid by Medicaid or self-paid. Hospital-level risk-standardized readmission rates (RSRRs) for surgical discharges were calculated. The association between hospital RSRRs and hospital characteristics was evaluated with bivariate analyses. An estimated multivariable hierarchical linear regression model was used to examine variation in hospital RSRRs, adjusting for hospital characteristics, state, year, and SNH status. Data were analyzed from June 1, 2017, through March 1, 2018. Exposures Surgical care at an SNH. Main Outcomes and Measures Readmission after an index surgical admission. Results A total of 1 252 505 patients across all 4 years and states were included in the analysis (51.7% women; mean [SD] age, 52.7 [18.1] years). Bivariate analyses found that SNHs had higher mean (SD) surgical RSRRs compared with non-SNHs; significant differences were found for New York (9.6 [0.1] vs 10.9 [0.1];P Conclusions and Relevance According to results of this study, surgical patients treated at SNHs experienced slightly higher RSRRs compared with those treated at non-SNHs. This association persisted after adjusting for year, state, and hospital factors, including teaching status, hospital bed size, and hospital volume.
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the agency for Healthcare Research and quality inpatient quality indicator 11 overall mortality rate does not accurately assess mortality risk after abdominal aortic aneurysm repair
Journal of Vascular Surgery, 2015Co-Authors: William P Robinson, Wei Huang, Amy K Rosen, Andres Schanzer, Hua Fang, Frederick A Anderson, Louis M MessinaAbstract:Objective The Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicator (IQI) #11, abdominal aortic aneurysm (AAA) repair mortality rate, is a measure of hospital quality that is publically reported but has not been externally validated. Because the IQI #11 overall mortality rate includes both intact and ruptured aneurysms and open and endovascular repair, we hypothesized that IQI #11 overall mortality rate does not provide accurate assessment of mortality risk after AAA repair and that AAA mortality cannot be accurately assessed by a single quality measure. Methods Using AHRQ IQI software version 4.2, we calculated observed (O) and expected (E) mortality rates for IQI #11 for all hospitals performing more than 10 AAA repairs per year in the Nationwide Inpatient Sample for the years 2007 to 2011. We used Spearman correlation coefficient to compare expected rates as determined by IQI #11 overall mortality rate risk adjustment methodology and observed rates for all AAA repairs in four cohorts stratified by aneurysm stability (ruptured vs intact) and method of repair (open vs endovascular). Results Among 187,773 AAA repairs performed at 1268 U.S. hospitals, hospitals' IQI #11 overall expected rates correlated poorly with their observed rates (E: 5.0% ± 4.4% vs O: 6.0% ± 9.8%; r = .49). For ruptured AAAs, IQI #11 overall mortality rate methodology underestimated the mortality risk of open repair (E: 34% ± 7.2% vs O: 40.1% ± 38.2%; r = 0.20) and endovascular repair (E: 24.8% ± 9% vs O: 27.3% ± 37.9%; r = 0.08). For intact AAA repair, IQI #11 overall mortality rate methodology underestimated the mortality risk of open repair (E: 4.3% ± 2.4% vs O: 6.3% ± 16.1%; r = .24) but overestimated the mortality risk of endovascular repair (E: 1.3% ± 0.8% vs O: 1.1% ± 3.7%; r = 0.25). Hospitals' observed mortality rates after intact AAA repair were not correlated with their mortality rates after ruptured AAA repair ( r = 0.03). Conclusions IQI #11 overall mortality rate fails to provide accurate assessment of inpatient mortality risk after AAA repair. Thus, it is inappropriate to use IQI #11 overall mortality rate for quality reporting. The accuracy of separate quality measures that assess mortality risk after repair of ruptured and intact AAAs, stratified by the use of open or endovascular repair, should be examined.
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comparison of the agency for Healthcare Research and quality patient safety indicator rates among veteran dual users
American Journal of Medical Quality, 2014Co-Authors: Qi Chen, Amresh D Hanchate, Michael Shwartz, Ann M Borzecki, Hillary J Mull, Marlena H Shin, Amy K RosenAbstract:This study compares rates of 11 Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) among 266 203 veteran dual users (ie, those with hospitalizations in both the Veterans Health Administration [VA] and the private sector through Medicare fee-for-service coverage) during 2002 to 2007. PSI risk-adjusted rates were calculated using the PSI software (version 3.1a). Rates of pressure ulcer, central venous catheter-related bloodstream infections, and postoperative sepsis, areas in which the VA has focused quality improvement efforts, were found to be significantly lower in the VA than in the private sector. VA had significantly higher rates for 7 of the remaining 8 PSIs, although the rates of only 2 PSIs (postoperative hemorrhage/hematoma and accidental puncture or laceration) remained higher in the VA after sensitivity analyses were conducted. A better understanding of system-level differences in coding practices and patient severity, poorly documented in administrative data, is needed ...
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validating the patient safety indicators in the veterans health administration do they accurately identify true safety events
Medical Care, 2012Co-Authors: Amy K Rosen, Susan Loveland, Qi Chen, Amresh D Hanchate, Michael Shwartz, Marlena H Shin, Kamal M F Itani, Marisa Cevasco, Haytham M A Kaafarani, Ann M BorzeckiAbstract:Background:The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) use administrative data to detect potentially preventable in-hospital adverse events. However, few studies have determined how accurately the PSIs identify true safety events.Objectives:We examined the
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evaluating the patient safety indicators how well do they perform on veterans health administration data
Medical Care, 2005Co-Authors: Amy K Rosen, Peter E Rivard, Shibei Zhao, Susan Loveland, Dennis Tsilimingras, Cindy L Christiansen, Anne ElixhauserAbstract:Background:The Patient Safety Indicators (PSIs), an administrative data-based tool developed by the Agency for Healthcare Research and Quality, are increasingly being used to screen for potential in-hospital patient safety problems. Although the Veterans Health Administration (VA) is a national lead
Garth H Utter - One of the best experts on this subject based on the ideXlab platform.
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postoperative respiratory failure an update on the validity of the agency for Healthcare Research and quality patient safety indicator 11 in an era of clinical documentation improvement programs
American Journal of Surgery, 2020Co-Authors: Jacqueline Stocking, Garth H Utter, Christiana Drake, Matthew J Aldrich, Alpesh Amin, Rebecca A Marmor, Laura N Godat, Maxime Cannesson, Michael A Gropper, Patrick S RomanoAbstract:Abstract Background Administrative data can be used to identify cases of postoperative respiratory failure (PRF). We aimed to determine if recent changes to the Agency for Healthcare Research and Quality Patient Safety Indicator 11 (PSI 11) and adoption of clinical documentation improvement programs have improved the validity of PSI 11. We also analyzed reasons why PSI 11 was falsely triggered. Study design Cross-sectional study of all eligible discharges using health record data from five academic medical centers between October 1, 2012 and September 30, 2015. Results Of 437 flagged records, 434 (99.3%) were accurately coded and 414 (94.7%) represented true clinical PRF. None of the false positive records involved respiratory failure present on admission. Most (78.3%) false positive records required airway protection but did not have respiratory failure. Conclusion The validity of PSI 11 has improved with recent changes to the code criterion and adoption of clinical documentation improvement programs.
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using the agency for Healthcare Research and quality patient safety indicators for targeting nursing quality improvement
Journal of Nursing Care Quality, 2012Co-Authors: Patricia A Zrelak, Banafsheh Sadeghi, Garth H Utter, Ruth Baron, Joanne Cuny, Patrick S RomanoAbstract:Quantifying the critical impact nurses have on the prevention and early recognition of potential complications and adverse events, such as those identified by the Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSI), is becoming increasingly important. In this paper, we describe how the AHRQ PSI may be used to identify nursing-specific opportunities to improve care based on data from the national AHRQ PSI validation pilot project.
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positive predictive value of the agency for Healthcare Research and quality patient safety indicator for central line related bloodstream infection selected infections due to medical care
Journal for Healthcare Quality, 2011Co-Authors: Patricia A Zrelak, Banafsheh Sadeghi, Daniel J Tancredi, Garth H Utter, Ruth Baron, Jeffrey J Geppert, Patrick S RomanoAbstract:Abstract: As part of the Agency for Healthcare Research and Quality Patient Safety Indicator (PSI) Validation Pilot Project, we evaluated the criterion validity of PSI 7. At the time of this study, PSI 7 was entitled “Selected Infections Due to Medical Care” and targeted catheter-related infections and inflammatory reactions. We conducted a retrospective cross-sectional study of 23 volunteer U.S. hospitals, where trained abstractors reviewed a sample of records that met PSI 7 criteria from October 1, 2005 to March 31, 2007. Of the 191 cases that met PSI 7 criteria, 104 (positive predictive value = 54%, 95% confidence interval: 40–69%) represented true infections. Of these cases, 77 (74%) were associated with central venous catheters, 15 (15%) were associated with peripheral intravenous (n=13) and or or arterial catheters (n=6), and 12 (11%) were associated with unknown catheters. Of the 87 (46%) false-positive cases, 41 (47%) did not have a qualifying infection identified by the abstractor, 38 (44%) had an infection present on admission, and 8 (9%) had an exclusionary diagnosis. PSI 7 has a low positive predictive value compared with other PSIs recently studied. Present on admission diagnoses and improved coding for infections related to central venous catheters (implemented October 2007) may improve validity.
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detection of postoperative respiratory failure how predictive is the agency for Healthcare Research and quality s patient safety indicator
Journal of The American College of Surgeons, 2010Co-Authors: Garth H Utter, Patricia A Zrelak, Ruth Baron, Joanne Cuny, Pradeep Sama, Michael R Silver, Saskia E Drosler, Patrick S RomanoAbstract:Background Patient Safety Indicator (PSI) 11, or postoperative respiratory failure, was developed by the US Agency for Healthcare Research and Quality to detect incident cases of respiratory failure after elective operations through use of ICD-9-CM diagnosis and procedure codes. We sought to determine the positive predictive value (PPV) of this indicator. Study Design We conducted a retrospective cross-sectional study, sampling consecutive cases that met PSI 11 criteria from 18 geographically diverse academic medical centers on or before June 30, 2007. Trained abstractors from each center reviewed medical records using a standard instrument. We assessed the PPV of the indicator (with 95% CI adjusted for clustering within centers) and conducted descriptive analyses of the cases. Results Of 609 cases that met PSI 11 criteria, 551 (90.5%; 95% CI, 86.5–94.4%) satisfied the technical criteria of the indicator and 507 (83.2%; 95% CI, 77.2–89.3%) represented true cases of postoperative respiratory failure from a clinical standpoint. The most frequent reasons for being falsely positive were nonelective hospitalization, prolonged intubation for airway protection, and insufficient evidence to support a diagnosis of acute respiratory failure. Fifty percent of true-positive cases involved substantial baseline comorbidities, and 23% resulted in death. Conclusions Although PSI 11 predicts true postoperative respiratory failure with relatively high frequency, the indicator does not limit detection to preventable cases. The PPV of PSI 11 might be increased by excluding cases with a principal diagnosis suggestive of a nonelective hospitalization and those with head or neck procedures. Removing the diagnosis code criterion from the indicator might also increase PPV, but would decrease the number of true positive cases detected by 20%.
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positive predictive value of the ahrq accidental puncture or laceration patient safety indicator
Annals of Surgery, 2009Co-Authors: Garth H Utter, Banafsheh Sadeghi, Daniel J Tancredi, Patricia A Zrelak, Ruth Baron, Jeffrey J Geppert, Patrick S RomanoAbstract:Objective:Patient Safety Indicator (PSI) 15, or “Accidental Puncture or Laceration” (APL), of the US Agency for Healthcare Research and Quality was recently endorsed as a consensus standard for quality of care by the National Quality Forum. We sought to determine the positive predictive value (PPV)
Patricia A Zrelak - One of the best experts on this subject based on the ideXlab platform.
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improved coding of postoperative deep vein thrombosis and pulmonary embolism in administrative data ahrq patient safety indicator 12 after introduction of new icd 9 cm diagnosis codes
Medical Care, 2015Co-Authors: Banafsheh Sadeghi, Patricia A Zrelak, Richard H White, Gregory A Maynard, Amy Strater, Laurie Hensley, Julie Cerese, Patrick S RomanoAbstract:Background:Symptomatic venous thromboembolism is a common postoperative complication. The Agency for Healthcare Research and Quality (AHRQ) has developed a Patient Safety Indicator 12 to assist hospitals, payers, and other stakeholders to identify patients who experienced this complication.Objective
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using the agency for Healthcare Research and quality patient safety indicators for targeting nursing quality improvement
Journal of Nursing Care Quality, 2012Co-Authors: Patricia A Zrelak, Banafsheh Sadeghi, Garth H Utter, Ruth Baron, Joanne Cuny, Patrick S RomanoAbstract:Quantifying the critical impact nurses have on the prevention and early recognition of potential complications and adverse events, such as those identified by the Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSI), is becoming increasingly important. In this paper, we describe how the AHRQ PSI may be used to identify nursing-specific opportunities to improve care based on data from the national AHRQ PSI validation pilot project.
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positive predictive value of the agency for Healthcare Research and quality patient safety indicator for central line related bloodstream infection selected infections due to medical care
Journal for Healthcare Quality, 2011Co-Authors: Patricia A Zrelak, Banafsheh Sadeghi, Daniel J Tancredi, Garth H Utter, Ruth Baron, Jeffrey J Geppert, Patrick S RomanoAbstract:Abstract: As part of the Agency for Healthcare Research and Quality Patient Safety Indicator (PSI) Validation Pilot Project, we evaluated the criterion validity of PSI 7. At the time of this study, PSI 7 was entitled “Selected Infections Due to Medical Care” and targeted catheter-related infections and inflammatory reactions. We conducted a retrospective cross-sectional study of 23 volunteer U.S. hospitals, where trained abstractors reviewed a sample of records that met PSI 7 criteria from October 1, 2005 to March 31, 2007. Of the 191 cases that met PSI 7 criteria, 104 (positive predictive value = 54%, 95% confidence interval: 40–69%) represented true infections. Of these cases, 77 (74%) were associated with central venous catheters, 15 (15%) were associated with peripheral intravenous (n=13) and or or arterial catheters (n=6), and 12 (11%) were associated with unknown catheters. Of the 87 (46%) false-positive cases, 41 (47%) did not have a qualifying infection identified by the abstractor, 38 (44%) had an infection present on admission, and 8 (9%) had an exclusionary diagnosis. PSI 7 has a low positive predictive value compared with other PSIs recently studied. Present on admission diagnoses and improved coding for infections related to central venous catheters (implemented October 2007) may improve validity.
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detection of postoperative respiratory failure how predictive is the agency for Healthcare Research and quality s patient safety indicator
Journal of The American College of Surgeons, 2010Co-Authors: Garth H Utter, Patricia A Zrelak, Ruth Baron, Joanne Cuny, Pradeep Sama, Michael R Silver, Saskia E Drosler, Patrick S RomanoAbstract:Background Patient Safety Indicator (PSI) 11, or postoperative respiratory failure, was developed by the US Agency for Healthcare Research and Quality to detect incident cases of respiratory failure after elective operations through use of ICD-9-CM diagnosis and procedure codes. We sought to determine the positive predictive value (PPV) of this indicator. Study Design We conducted a retrospective cross-sectional study, sampling consecutive cases that met PSI 11 criteria from 18 geographically diverse academic medical centers on or before June 30, 2007. Trained abstractors from each center reviewed medical records using a standard instrument. We assessed the PPV of the indicator (with 95% CI adjusted for clustering within centers) and conducted descriptive analyses of the cases. Results Of 609 cases that met PSI 11 criteria, 551 (90.5%; 95% CI, 86.5–94.4%) satisfied the technical criteria of the indicator and 507 (83.2%; 95% CI, 77.2–89.3%) represented true cases of postoperative respiratory failure from a clinical standpoint. The most frequent reasons for being falsely positive were nonelective hospitalization, prolonged intubation for airway protection, and insufficient evidence to support a diagnosis of acute respiratory failure. Fifty percent of true-positive cases involved substantial baseline comorbidities, and 23% resulted in death. Conclusions Although PSI 11 predicts true postoperative respiratory failure with relatively high frequency, the indicator does not limit detection to preventable cases. The PPV of PSI 11 might be increased by excluding cases with a principal diagnosis suggestive of a nonelective hospitalization and those with head or neck procedures. Removing the diagnosis code criterion from the indicator might also increase PPV, but would decrease the number of true positive cases detected by 20%.
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positive predictive value of the ahrq accidental puncture or laceration patient safety indicator
Annals of Surgery, 2009Co-Authors: Garth H Utter, Banafsheh Sadeghi, Daniel J Tancredi, Patricia A Zrelak, Ruth Baron, Jeffrey J Geppert, Patrick S RomanoAbstract:Objective:Patient Safety Indicator (PSI) 15, or “Accidental Puncture or Laceration” (APL), of the US Agency for Healthcare Research and Quality was recently endorsed as a consensus standard for quality of care by the National Quality Forum. We sought to determine the positive predictive value (PPV)
Elizabeth C Wick - One of the best experts on this subject based on the ideXlab platform.
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surgical technical evidence review for gynecologic surgery conducted for the agency for Healthcare Research and quality safety program for improving surgical care and recovery
Obstetrical & Gynecological Survey, 2019Co-Authors: Eleftheria Kalogera, Gregg Nelson, Jessica Y Liu, Elizabeth C Wick, Sean C DowdyAbstract:(Abstracted from Am J Obstet Gynecol 2018;219:563.e1–563.e19)The Safety Program for Improving Surgical Care and Recovery (ISCR) was developed by the Agency for Healthcare Research and Quality (AHRQ) in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institu
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evidence review conducted for the agency for Healthcare Research and quality safety program for improving surgical care and recovery focus on anesthesiology for total knee arthroplasty
Anesthesia & Analgesia, 2019Co-Authors: Ellen M Soffin, Elizabeth C Wick, Maxime Cannesson, Melinda Maggard Gibbons, Stephen L Kates, Michael J ScottAbstract:Enhanced recovery after surgery (ERAS) protocols represent patient-centered, evidence-based, multidisciplinary care of the surgical patient. Although these patterns have been validated in numerous surgical specialities, ERAS has not been widely described for patients undergoing hip fracture (HFx) repair. As part of the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery, we have conducted a full evidence review of interventions that form the basis of the anesthesia components of the ERAS HFx pathway. A literature search was performed for each protocol component, and the highest levels of evidence available were selected for review. Anesthesiology components of care were identified and evaluated across the perioperative continuum. For the preoperative phase, the use of regional analgesia and nonopioid multimodal analgesic agents is suggested. For the intraoperative phase, a standardized anesthetic with postoperative nausea and vomiting prophylaxis is suggested. For the postoperative phase, a multimodal (primarily nonopioid) analgesic regimen is suggested. A summary of the best available evidence and recommendations for inclusion in ERAS protocols for HFx repair are provided.
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evidence review conducted for the agency for Healthcare Research and quality safety program for improving surgical care and recovery focus on anesthesiology for total knee arthroplasty
Anesthesia & Analgesia, 2019Co-Authors: Ellen M Soffin, Elizabeth C Wick, Maxime Cannesson, Melinda Maggard Gibbons, Stephen L Kates, Michael J ScottAbstract:The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, has developed the Safety Program for Improving Surgical Care and Recovery (ISCR), which is a national effort to disseminate best practices in perioperative care to more than 750 hospitals across multiple procedures in the next 5 years. The program will integrate evidence-based processes central to enhanced recovery and prevention of surgical site infection, venous thromboembolic events, catheter-associated urinary tract infections with socioadaptive interventions to improve surgical outcomes, patient experience, and perioperative safety culture. The objectives of this review are to evaluate the evidence supporting anesthesiology components of colorectal (CR) pathways and to develop an evidence-based CR protocol for implementation. Anesthesiology protocol components were identified through review of existing CR enhanced recovery pathways from several professional associations/societies and expert feedback. These guidelines/recommendations were supplemented by evidence made further literature searches. Anesthesiology protocol components were identified spanning the immediate preoperative, intraoperative, and postoperative phases of care. Components included carbohydrate loading, reduced fasting, multimodal preanesthesia medication, antibiotic prophylaxis, blood transfusion, intraoperative fluid management/goal-directed fluid therapy, normothermia, a standardized intraoperative anesthesia pathway, and standard postoperative multimodal analgesic regimens.
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surgical technical evidence review for gynecologic surgery conducted for the agency for Healthcare Research and quality safety program for improving surgical care and recovery
American Journal of Obstetrics and Gynecology, 2018Co-Authors: Eleftheria Kalogera, Gregg Nelson, Jessica Y Liu, Elizabeth C Wick, Sean C DowdyAbstract:Background The Agency for Healthcare Research and Quality, in partnership with the American College of Surgeons and the Armstrong Institute at Johns Hopkins, developed the Safety Program for Improving Surgical Care and Recovery, which integrates principles of implementation science into adoption of enhanced recovery pathways and promotes evidence-based perioperative care. Objective The objective of this study is to review the enhanced recovery pathways literature in gynecologic surgery and provide the framework for an Improving Surgical Care and Recovery pathway for gynecologic surgery. Study Design We searched PubMed and Cochrane Central Register of Controlled Trials databases from 1990 through October 2017. Studies were included in hierarchical and chronological order: meta-analyses, systematic reviews, randomized controlled trials, and interventional and observational studies. Enhanced recovery pathways components relevant to gynecologic surgery were identified through review of existing pathways. A PubMed search for each component was performed in gynecologic surgery and expanded to include colorectal surgery as needed to have sufficient evidence to support or deter a process. This review focuses on surgical components; anesthesiology components are reported separately in a companion article in the anesthesiology literature. Results Fifteen surgical components were identified: patient education, bowel preparation, elimination of nasogastric tubes, minimization of surgical drains, early postoperative mobilization, early postoperative feeding, early intravenous fluid discontinuation, early removal of urinary catheters, use of laxatives, chewing gum, peripheral mu antagonists, surgical site infection reduction bundle, glucose management, and preoperative and postoperative venous thromboembolism prophylaxis. In addition, 14 components previously identified in the colorectal Improving Surgical Care and Recovery pathway review were included in the final pathway. Conclusion Evidence and existing guidelines support 29 protocol elements for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery in gynecologic surgery.
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surgical technical evidence review for elective total joint replacement conducted for the ahrq safety program for improving surgical care and recovery
Geriatric Orthopaedic Surgery & Rehabilitation, 2018Co-Authors: Christopher P Childers, Elizabeth C Wick, Stephen L Kates, Anaar Siletz, Emily S Singer, Claire M Faltermeier, Gregory J Golladay, Melinda MaggardgibbonsAbstract:Background:Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; fu...
