In 2006 the ICU initiated new protocols for early extubation (< 6 hours) for nonemergent CABG patients. Also, physician extender staffing has been increased to 24 hours a day in order to more closely monitor postop patients. In July of 2006 Anesthesiology selected 5 anesthesiologists with expertise in cardiac surgery that are committed to be available for all open heart surgeries - 24-7. They have also added a 6th provider with special expertise in intraoperative transesophageal echo studies.

There is ongoing collaboration between the Cath Lab and the emergency departments of all system facilities to continually decrease the time from diagnosis of ST elevation to PCI.

All AAA patients are now being screened to determine whether or not they are eligible for an endovascular (less invasive) procedure. Only patients that are contraindicated for an endovascular approach are having open procedures.

CEA patients at HFH are receiving duplex scans of a higher diagnostic quality prior to surgery. The Vascular Surgeons have also convened a multidisciplinary Carotid Board that meets weekly to review patients with upcoming surgeries. This board deterrmines the best surgical approach for each patient. Dr. Reddy, division chief of Vascular Surgery, is the principle investigator for the NIH CREST trial - which is comparing endovascular (closed) versus open approach for CEAs.

Our surgeons developed a modification to the standard Ivor-Lewis esophagectomy--the split stomach fundoplication--which has eliminated postoperative anastomotic leaks and reduced post-esophagectomy reflux. (published in the Journal of Gastrointestinal Surgery Feb, 2006).

In April of 2006 an Oxygen saturation monitoring protocol was implemented to decrease the incidence of ROP and BPD in this high risk population. We have also implemented an Infection Control initiative which includes hand washing surveillance, central venous catheter insertion bundle, modification of PICC line dressing changes, removal of high medium solutions earlier, and early discontinuation of central lines. This has been a phased implementation which started in 2004 and was completed first quarter 2006.