Improving Incidence of Postoperative Atrial Fibrillation After Cardiac Surgery Using Simplified Clinical Practice Guidelines

Abstract

Objectives: Postoperative atrial fibrillation (POAF) remains a major risk after cardiac surgery. Twelve percent patients admitted to this unit postcardiac surgery experienced POAF, which led to hemodynamic instability, increased risk of stroke, and increased length of postoperative intensive care unit stay. Our aim was to decrease the incidence of POAF in the cardiothoracic intensive care unit by the end of April 2014. Methods: Design—Retrospective data analysis. Settings—Postcardiac surgery intensive care in a tertiary hospital. Participants: Postcardiac surgery patients. Intervention—A clinical practice guideline (CPG) was developed to promote early prevention and to improve adherence to POAF prophylaxis recommendations. Patient’s charts were our key performance indicator. Primary outcome measure—Percentage of patients who developed episodes of POAF within the first 24 hours of cardiac surgery. Process measures—compliance with the newly developed CPG and early postoperative patient assessment. Balance measure—early administration of β-blocker. Results: We were able to decrease POAF to 8% after intervention. Compliance with early assessment improved from 25% to 87%. Compliance with adherence to the CPG was 80%. Adherence to the newly developed paper form was the major challenge that could be overcome by an electronic form. We hope to decrease the incidence of POAF to 6% and develop an electronic form by the end of December 2014. Conclusion: This quality improvement project changed the strategy and succeeded in decreasing the incidence of POAF after cardiac surgery. It also improved early assessment of risk factors.