Impact of a Standardized Postoperative Atrial Fibrillation Protocol in Isolated CABG Surgery
A retrospective analysis compared outcomes of isolated coronary artery bypass graft (CABG) patients before and after implementing a standardized postoperative atrial fibrillation (POAF) protocol. The protocol reduced POAF incidence from 30% to 10% (p<0.05) and readmission rates from 10% to 2%. ICU length of stay (LOS) decreased from 6.6 to 3.8 days (p<0.002), saving $8,400 per patient. Overall LOS dropped from 11 to 8.9 days (p=0.25), saving $1,575 per patient. Financial analysis showed cost savings of $750 per patient day for step-down/telemetry care and $3,000 per ICU patient day.
Problem: Postoperative atrial fibrillation (POAF) is a common complication following isolated coronary artery bypass graft (CABG) surgery, contributing to increased hospital length of stay (LOS) and rising healthcare costs. This study evaluated whether implementing a standardized POAF protocol reduced POAF incidence, decreased LOS, and lowered healthcare expenditures compared to standard care
Measurement: Patient data was collected for three months before and after POAF protocol implementation, assessing new-onset AF, LOS, and healthcare costs. Post-protocol data were compared to pre-protocol metrics using bar graphs and statistical analysis, including tests for significance.
Analysis: This retrospective cohort study assessed the POAF Protocol's impact on postoperative AF, hospital stay, and costs using descriptive and inferential statistics, including chi-square tests and t-tests. Outcomes after implementing prophylactic amiodarone and risk-based adjunctive therapies were analyzed.
Implementation: A standardized POAF protocol was developed and integrated into the EHR after a literature review and stakeholder engagement. Provider and nursing teams received targeted training. The protocol included pre/intra/postop amiodarone administration, beta-blockers, colchicine, and strict electrolyte management. Challenges included bradycardia, practice variations, and interdisciplinary education barriers affecting protocol adherence.
Results/Discussion: The POAF protocol reduced new-onset AF from 30% to 10% (p<0.05) and readmission rates from 10% to 2%. ICU LOS decreased from 6.6 to 3.8 days (p<0.002), saving $8,400 per patient. Overall LOS dropped to 8.9 days, with significant cost savings across care levels. Sustainability requires continuous evaluation and education.
Speakers
Manager of Operations - Memorial Hermann Hospital System
Manager of Advanced Practice - Memorial Hermann Health System
Nurse Practitioner - Memorial Hermann Health System
CVICU APP - Memorial Hermann Health System
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Performance and Process Improvement
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Location Virtual
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Organizer NAHQ Next
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