Source · GIRFT National Specialty Report
Cardiothoracic Surgery
GIRFT Programme National Specialty Report on cardiothoracic surgery
Published 1 March 2018
Cardiothoracic Surgery
Indexed content
20 recommendations
11 addressees
2 of 20 linked to a body
Recommendations
Make day of surgery admission routine practice.
Ring-fence beds on ward and ITU for elective cardiothoracic surgery.
Establish regional work-up protocols for non-elective referrals.
Pool non-elective cases ready for next available theatre session and next available appropriate surgeon.
Ensure that every patient is reviewed by a consultant pre- and post-operatively – and that this happens seven days a week.
Establish a formal Standard Operating Procedure on cardiothoracic data validation, risk adjustment, outlier identification, escalation plans and reporting for GIRFT metrics.
7a Use uniform draping technique in theatre
7b Use chlorhexidene skin preparation
7c Ensure that individual cases of deep sternal wound infection (DSWI) are reviewed by a multidisciplinary team, led by a consultant microbiologist.
8a Establish a national formal policy for complex and very high-risk cases.
8b Establish collective responsibility for clinical outcomes.
Attribute outcomes for complex and very high-risk cases to units rather than to individuals.
Record blood product transfusion rates for cardiac surgery.
11a Centralise and reduce the number of lung cancer multidisciplinary teams (MDTs).
11b Ensure that a thoracic surgeon is present at every lung cancer MDT.
Ensure that patients being treated with surgery for Stage 1 lung cancer receive VATS or robotic-assisted lobectomy as the treatment of choice.
13a Ensure that patients who do not recover from medical treatment of empyema within 5-7 days are assessed by a thoracic surgeon.
13b When possible, routinely use VATS rather than open operation to manage empyema.
Full addressee: British Thoracic Society; Providers
Ensure that acute aortic syndrome patients are only operated on by rotas of acute aortic syndrome specialist teams.
Ensure that patients with degenerative mitral valve disease are only operated on by specialist mitral valve surgeons.
Ensure that major trauma centres are covered by published rotas for both thoracic and cardiac trauma. Providers should end of the practice of using full-time, cardiac-dedicated surgeons to provide emergency thoracic surgery cover.
Review the list of complications and comorbidities for cardiothoracic surgery, so that only codes that are genuinely relevant to the cost of treatment trigger a cc score in pricing, and that the HRG splits reflect an authentic variation in cost.
Full addressee: NHS Digital
Increase collaboration between clinical cardiothoracic teams and coders by including coders in multidisciplinary team meetings (MDTMs) and morbidity and mortality meetings.
NICOR should work with providers to improve the quality of data submitted and stored, specifically for
• return to theatre
• deep sternal wound infection
• new CVA
• post-operative renal replacement therapy.
Implement GIRFT 5 point plan for reducing litigation costs.