Quality Care Outcomes in Cardiac Surgery: The Role of Evidence-based Practice
- 1 November 2001
- journal article
- Published by AACN Publishing in AACN Advanced Critical Care
- Vol. 12 (4) , 606-617
- https://doi.org/10.1097/00044067-200111000-00017
Abstract
An internal database and research methods were used to evaluate the impact of clopidogrel on cardiac surgical bleeding. This quality improvement initiative, led by the clinical nurse specialist, showed that preoperative exposure to clopidogrel was associated with significant increases in chest tube output, blood product use, and reoperation for bleeding rates that were 10-fold higher than for control patients (0.85% versus 8.3%, P = 0.027). Acute care costs averaged $2,680 more for patients who received clopidogrel (P = 0.1936). After implementation of an interdepartmental clinical practice guideline, preoperative exposure to clopidogrel dropped from 39% to 6.3% (P = 0.0000). This drop was accompanied by reductions in chest tube output, blood product use, and bleeding complications, with improved achievement of clinical benchmarks. The availability of internal evidence to support achievement of best practices was an essential factor in the implementation of this interdepartmental change. Comprehensive database systems and advanced practice nurses are highlighted as essential components of evidence-based programs.Keywords
This publication has 18 references indexed in Scilit:
- Thrombotic Thrombocytopenic Purpura and Clopidogrel — A Need for New Approaches to Drug SafetyNew England Journal of Medicine, 2000
- Use of clopidrogel in coronary stenting: what was the question?∗∗Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology.Journal of the American College of Cardiology, 1999
- A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical CareNew England Journal of Medicine, 1999
- Getting research findings into practice: Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findingsBMJ, 1998
- Variability in Transfusion Practice for Coronary Artery Bypass Surgery Persists Despite National Consensus GuidelinesAnesthesiology, 1998
- Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: A prospective randomized controlled trialThe Journal of Thoracic and Cardiovascular Surgery, 1996
- A Randomized Comparison of Antiplatelet and Anticoagulant Therapy after the Placement of Coronary-Artery StentsNew England Journal of Medicine, 1996
- North of England evidence based guidelines development project: methods of guideline developmentBMJ, 1996
- Users' guides to the medical literature. VIII. How to use clinical practice guidelines. A. Are the recommendations valid? The Evidence-Based Medicine Working GroupPublished by American Medical Association (AMA) ,1995
- The Clinical Nurse Specialist as Case Manager in a Collaborative Practice ModelClinical Nurse Specialist, 1992