Foundation Program Sites
Quality Improvement Initatives

While ongoing data assessment, reporting, and identification of best practice is core to COAP’s quality improvement work, we also partner with other programs and organizations to launch broader quality initiatives. COAP is currently engaged in the following initiatives:

 

Patient Blood Management in Cardiac Surgery

COAP has a strong track record of supporting member hospitals in reducing blood use in adult cardiac surgery. Washington state boasts the lowest blood use rates in the nation thanks to more than ten years of focused efforts around data collection, reporting, and facilitating collaborations that share expertise and best practices in blood management across the region. Yet even with this success, there is still considerable variation in blood use among our region’s cardiac surgery sites, and room for improvement.

COAP has partnered with the Washington State Hospital Association (WSHA) to become the first state in the nation to implement patient blood  management standards of care in cardiac surgery. COAP is providing blood use data and reporting; WSHA is supporting best practice implementation. 

The benefits to patients of reducing blood use and implementing patient blood management standards of care have been well researched and documented over the past twenty years. These benefits include reductions in: pulmonary complications, infections, chronic disease morbidities exacerbation, adverse surgical outcomes associated with preoperative anemia and/or iron deficiency, hospital length of stay, hospital readmissions, and cost of care. 

Currently 11 of 17 cardiac surgery sites participate in the Patient Blood Management Initiative: Central Washington Hospital, Harrison Medical Center, Overlake Hospital, Providence Regional Medical Center Everett, Providence Sacred Heart, Southwest Hospital, St. Joseph Medical Center Tacoma, Swedish Health Services, Tacoma General, University of Washington Medical Center, and Virginia Mason Hospital. If you are a cardiac surgeon or hospital administrator at a non-participating site and would like to learn more, please contact us today.

 

Moving the Needle Campaign

The goal of this Foundation-wide campaign is to encourage collaboration across the diverse spectrum of providers providing peri-operative patient care as a way to address our ongoing challenges with opioid prescribing.

There has been intense focus on decreasing opioid related deaths. While significant overall progress has been made, we believe that bringing focused attention to peri-operative opioid prescribing practices will further move the needle.

Tying practice patterns to data will concretely demonstrate to providers how their actions directly affect patient safety and opioid use. Our Care Outcomes Assessment Programs’ (COAPs) unique ability to gather meaningful data will enable providers to measure the changes they are making and compare those changes with their peers.

Our attention was brought to this aspect of the opioid crisis through the Bree Collaborative’s Opioid Prescribing Workgroup, who noted “…recent studies show that patients often receive more opioids for home use than are necessary for pain related to many procedures…. Increased duration of initial opioid prescription has also been associated with increased incidence of chronic opioid use and risk of opioid misuse and overdose.”[1]  The Workgroup also noted that patients who bring home more pills than they need risk illegal diversion of their opioid prescription.

Recent changes in the state regulations enable linking the Prescription Monitoring Program data with COAP registries. This is an unprecedented opportunity to gain insight into statewide prescribing patterns and will further inform our efforts to Move the Needle.

In addition to focusing on opioid prescribing practices, COAP is exploring other ways of improving care for cardiac patients addicted to opioids. We are convening physicians to discuss the challenges in treating patients with infectious endocarditis, often the result of illicit drug use, and exploring the feasibility of establishing guidelines for care. COAP physicians are discussing the merits of Enhanced Recovery After Surgery (ERAS) and the role it might play in the campaign to better treat patients with opioid addiction. If you would like to join us in these efforts, please contact us today.

[1]Opioid Prescribing Workgroup. (2018) Prescribing Opioids for Postoperative Pain – Supplemental Guidance. Weir, V, ed. Seattle, WA: Dr. Robert Bree Collaborative.