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ProvenCare relies on evidence-based standards — what’s been shown in medicine to work best for patients — to guide surgery and post surgical care. Here are the 40 steps involved in ProvenCare for coronary artery bypass graft surgery:

Preadmission documentation

  • ACC/AHA indication
  • Screening for and consultation re: IMI (inferior myocardial infarction)/RV (right ventricular) involvement
  • Treatment options and patient preference
  • Need for warfarin - Ant.MI (myocardial infarction) or WMA (wall motion abnormality)
  • Current user of clopidogrel or warfarin?
  • Screening for stroke risk
  • Carotid doppler (if the test is indicated)
  • Vascular surgery consultation (if indicated)
  • Ejection fraction
  • Screening for need to use intra-aortic balloon pump (IABP)
  • Screening using epiaortic echo (as indicated)
  • Patient withheld clopidogrel/warfarin for 5 days pre-op

Operative documentation

  • Patient received correct dosing of beta-blocker (pre-op)
  • Correct use of intra-aortic balloon pump (pre-op -->post-op)
  • Pre-op Abx (within 60 minutes of incision; Vancomycin within 120 minutes)
  • Blood cardioplegia (on-pump patients)
  • Epiaortic echo of the ascending aorta and the peer consult
  • Intra-operative hyperglycemia screening
  • Correct insulin management (as indicated; per protocol)
  • Use of LIMA (left internal mammary artery) for LAD (left anterior descending) grafting

Post-Operative patient documentation

  • Anteroapical MI within prior 7 days: post-op echo
  • Monitoring for atrial fib for >48 hours
  • Anticoagulation therapy (as indicated)
  • Abx (antibiotics) administered (post-op for 24-48 hours)
  • Aspirin (six hours post-op or 24 hours post-op)
  • Beta-blocker (within 24 hours post-op)
  • Statin administered (post-op)
  • Surgical debridement and revascularization of any sternal wound infection
  • Plastic surgery consult regarding ongoing management of sternal wound
  • Tobacco screening and counseling

Discharge documentation

  • Referral to cardiac rehab
  • Discharge medications (e.g., beta-blocker)
  • Discharge medication: aspirin
  • Discharge medication: statin

Post-Discharge documentation

  • Patient correctly taking beta-blocker?
  • Patient correctly taking aspirin?
  • Patient correctly taking statin?
  • Patient correctly administering anticoagulant?
  • Did patient resume smoking?
  • Patient enrolled in cardiac rehab?