Benchmarks

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?