The University of Pennsylvania (Upenn) in conjunction with Evidence Based Perioperative Medicine (EBPOM) and UK Department for International Trade (DIT) has hosted the third annual “Quality Improvement Leadership Forum” with the goal of sharing experiences from the implementation of clinical initiatives. The forum was a collaboration of US and UK thought leaders from top teaching hospitals. The focus this year was on dissemination and implementation on the road to adoption of initiatives that improve patient outcomes.
One area of discussion was hemodynamic monitoring, centering on a presentation by UCL, London’s Professor Monty Mythen on the recently published (BJA) FEDORA study. Specifically the focus was on Goal-Directed Haemodynamic (rather than just Fluid) Therapy (GDHT vs GDFT). This combines managed delivery of fluids to maintain stroke volume, with inotropes and vasopressors to maintain target levels of mean arterial pressure and cardiac index (Deltex Medical’s Doppler-based ODM+ system is unique in its ability to guide vasoactive agents and inotropes along with fluid for complete haemodynamic therapy).
Not just for High Risk Patients
The FEDORA 420 patient randomised, controlled, multi centre trial yielded statistically significant data showing a 75% reduction of postoperative complications in patients considered to be at low-moderate risk, undergoing major elective surgery. Among the serious complications avoided were Acute Kidney Injury and Surgical Site Infection. Overall results showed a reduced length of hospital stay.
The group concluded that monitoring hemodynamics should be standard of care pre, during and post surgery. This then lead to discussion about how to deliver sustainable adoption of GDHT as a clinically supported best practice. The consensus was that horizontal implementation provides the best likelihood of success. This means introducing GDHT across the service as opposed to one surgical specialty at a time.
The forum agreed to generate two white papers. One will be a quick survey of opioid use, understanding how each hospital is addressing this ongoing crisis. The second paper will be about dissemination and implementation with the goal to come up with best practice on gaining adoption of new protocols and therapies.
