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Protocols and Recommendations

At the Virginia Cardiac Services Quality Initiative, we are committed to advancing the standards of cardiac healthcare across Virginia and beyond. This section of our website is dedicated to providing you with comprehensive and meticulously developed protocols and guidelines. These resources are designed to assist healthcare professionals in delivering consistent, high-quality cardiac care that is informed by the latest clinical evidence and best practices.

Explore Our Resources

Our protocols and guidelines cover a broad spectrum of cardiac care topics, each carefully crafted by experts in cardiology, cardiac surgery, and patient care management. Whether you are looking for innovative approaches to treatment, wanting to refine your existing practices, or seeking insights into complex clinical decisions, you'll find invaluable information here to guide you.

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Engage and Collaborate

Your feedback is invaluable. We invite you to:

  • Share Your Insights: If you have suggestions for improvements, or if there’s additional content you’d like to see, please let us know.

  • Join Our Community: Participate in discussions, workshops, and forums to collaborate with other professionals dedicated to improving cardiac care.

Tailored for Your Needs

We understand that each healthcare setting may have unique needs and challenges. That’s why our resources are designed to be adaptable:

  • Customizable Protocols: While our protocols are based on robust clinical data and expert consensus, we encourage healthcare providers to modify them as needed to enhance patient care in their specific contexts.

  • Up-to-Date Information: The field of cardiac care is ever-evolving. Our protocols are regularly reviewed and updated to reflect the latest research findings and technological advancements, ensuring you have access to the most current information.

Your Role in Shaping Cardiac Care

By utilizing these protocols and guidelines, you are joining a community of professionals dedicated to the highest standards of cardiac health services. Together, we can achieve better patient outcomes, reduce complications, and enhance the quality of life for those we serve.

Our Work

RBC Protocol

The "VCSQI RBC Protocol" is a comprehensive guideline developed by the Virginia Cardiac Services Quality Initiative (VCSQI), aimed at optimizing red blood cell transfusion practices in cardiac surgery across 17 hospitals and 13 surgical practices in Virginia. This multi-center protocol is focused on reducing unnecessary blood transfusions, which are common in cardiac surgery and associated with increased morbidity, prolonged hospital and ICU stays, and even elevated mortality rates post-surgery. Key components of the protocol include: -Transfusion Triggers: Establishing clear, evidence-based criteria for when transfusions should occur, such as hemoglobin levels below 6.0 or hematocrit below 18, along with signs of tissue hypoperfusion like low SVO2, elevated lactate, or low bicarbonate levels. -Postoperative Care: Guidelines for postoperative transfusions in ICU and step-down units, recommending transfusions for hemoglobin levels below 7.0 or hematocrit below 21, with additional criteria such as elevated oxygen needs, hypotension, end-organ dysfunction, or ongoing bleeding. -Blood Conservation: A detailed 9-12 point program aimed at conserving a patient's own blood and reducing reliance on transfusions, with a significant drop in transfusion rates from 70% to 12-22% of patients after program implementation. The protocol also highlights the differential impact of transfusions on male and female patients, noting that women often experience worse outcomes, potentially due to lower baseline blood volumes. This document serves as a vital resource for healthcare providers in cardiac surgery settings, offering a structured approach to blood transfusion that balances patient safety with resource efficiency. By adopting these guidelines, medical professionals can improve patient outcomes while addressing the substantial costs associated with unnecessary blood transfusions.

Created >2016

Readmission Protocols & Calculator

The "VCSQIVHAC Readmission Calculator" document presents a sophisticated tool developed jointly by the Virginia Hospitals and Healthcare Association (VHHA) and the Virginia Cardiac Services Quality Initiative (VCSQI). Designed to predict hospital readmission risks for patients undergoing Coronary Artery Bypass Grafting (CABG), this calculator integrates clinical, organizational, and socioeconomic factors to provide a comprehensive risk assessment. The document outlines the purpose of the tool—to identify patients at higher risk of post-CABG readmission—and details its operation. By entering specific patient data such as age, gender, COPD status, pre-procedure creatinine level, and socioeconomic factors, healthcare providers can receive a quantified risk score that guides postoperative care plans. The Readmission Risk Calculator is described as user-friendly and an essential resource for tailoring patient care more precisely, enhancing outcomes, and potentially reducing healthcare costs associated with readmissions. It emphasizes the importance of a holistic approach to patient care that considers a broad range of influencing factors. Ideal for cardiac care teams seeking to improve patient management after CABG surgery, this document offers a detailed guide on how to use the calculator effectively to predict and mitigate readmission risks. Obtain your copy to leverage this innovative tool in enhancing the quality of cardiac surgery recovery and care.

December 2023

Readmissions Protocol

The "VCSQI Readmissions Protocol" provides a comprehensive guide developed by the Virginia Cardiac Services Quality Initiative (VCSQI) to minimize hospital readmissions following heart surgery. Authored by Mohammed Quader, Denise Cox, Jennifer Whaley, and Eddie Fonner, this protocol details practical measures that healthcare facilities can adopt to reduce readmissions, which are a significant financial burden on the healthcare system. The protocol emphasizes the crucial role of a Discharge Planner in coordinating patient care before, during, and after hospitalization. It outlines specific interventions grouped into three phases: Before Surgery, After Surgery, and After Discharge, each with detailed actions aimed at addressing various risk factors and optimizing patient outcomes. Key strategies include: -Risk factor identification and optimization of pre-existing conditions such as diabetes and heart failure before surgery. -Comprehensive post-operative management, including extended monitoring for high-risk patients and engagement of the patient and family in education on medication and care procedures. -Post-discharge follow-up to ensure prescriptions are filled, and instructions are understood, alongside early enrollment in cardiac rehab and remote monitoring where necessary. The document also introduces advanced interventions like home monitoring and a dedicated minor procedure room in the clinic for continuous care. These strategies are designed to standardize care across surgeons and reduce variability, further decreasing the likelihood of readmission. This protocol is an invaluable resource for medical professionals looking to enhance the quality of cardiac care and reduce readmissions effectively. It serves as a guide to implementing a structured readmission reduction program that can significantly impact patient recovery and healthcare costs.

Created >2016

Prolonged Ventilation

The "Best Practice: VCSQI Prolonged Ventilation" is an expertly crafted guideline from the Virginia Cardiac Services Quality Initiative (VCSQI), focusing on reducing the duration of prolonged ventilation in cardiac surgery patients. This guideline addresses a critical complication in cardiac surgeries, where patients require ventilation for more than 24 hours post-operation—a situation that impacts recovery time, resource utilization, and overall hospital costs. Structured to enhance patient care quality, the document explains the definition of prolonged ventilation, the rationale behind the 24-hour threshold set by the Society of Thoracic Surgeons (STS), and provides historical data demonstrating significant improvements in patient outcomes due to optimized extubation practices. Key sections of this document offer practical strategies for reducing prolonged ventilation times, including setting proactive timers to remind medical staff to evaluate patients for possible extubation, and detailed action plans for meeting monthly improvement goals. This guide is essential for healthcare professionals dedicated to advancing cardiac care and improving surgical outcomes. By implementing these best practices, medical teams can significantly enhance patient recovery processes and achieve better performance metrics. Secure your copy today and contribute to elevating the standards of cardiac surgery care.

Created >2016

VCSQI Atrial Fibrillation Prophylaxis Protocol

The "VCSQI Atrial Fibrillation Prophylaxis Protocol" is an essential guide developed by the Virginia Cardiac Services Quality Initiative (VCSQI) to combat the common post-operative complication of atrial fibrillation in cardiac surgery patients. Atrial fibrillation can significantly delay patient recovery, extend hospital stays, and increase medical costs. This protocol outlines a proactive approach, starting from pre-surgical preparations to post-discharge management, focusing on medication strategies to reduce the incidence of new post-operative atrial fibrillation. Key components of the protocol include detailed medication guidelines such as the use of Amiodarone and Lopressor, specifying dosages based on patient weight and conditions, and providing clear exclusion criteria for each medication to ensure patient safety. The document is structured to assist healthcare professionals in implementing these guidelines effectively, with sections dedicated to prevention medications, treatment of breakthrough atrial fibrillation, and post-discharge management. It also addresses the management of medications in response to specific patient heart rates and the use of pacing and anticoagulation therapies. Ideal for cardiac care teams, this protocol serves as a critical resource in enhancing patient outcomes and optimizing the recovery process for those undergoing cardiac surgery. Obtain your copy today and empower your team with structured, evidence-based strategies to manage and prevent atrial fibrillation in surgical settings.

Created >2016

VCSQI AKI Reduction Recommendations and Suggestions for Care

The document is a detailed set of recommendations and guidelines titled "VCSQI AKI Reduction Recommendations and Suggestions for Care," dated January 19, 2022, and revised on January 20, 2023. It was developed by the Virginia Cardiac Services Quality Initiative (VCSQI) AKI Workgroup. The document outlines specific preoperative, intraoperative, and postoperative care suggestions aimed at reducing the incidence of Acute Kidney Injury (AKI) associated with cardiac procedures, including both catheterization and surgical interventions. The guidelines include: -Pre-catheterization recommendations, such as obtaining baseline serum creatinine levels, holding nephrotoxic medications, and calculating risk assessments. -Intra-procedure recommendations focused on managing contrast and fluid volumes, as well as real-time communication about patient status. -Post-procedure recommendations which emphasize monitoring serum creatinine, managing hydration, and reassessing medications. These recommendations are intended for use by cardiology and surgical teams to minimize AKI risks during and after cardiac procedures. The document also lists several key personnel involved in its creation, including medical professionals from various Virginia health institutions, acknowledging their contributions to developing these critical care standards.

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We Are Here to Support You

If you have questions or require further assistance regarding the application of any protocols, do not hesitate to contact us. Our team is here to support you in providing exceptional care to your patients.

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