Welcome Mid-Atlantic Data Managers (MACDM) 2018 Fall Meeting - - PowerPoint PPT Presentation

Welcome Mid-Atlantic Data Managers (MACDM) 2018 Fall Meeting – Tuesday, November 27, 2018

Thanks to our host Lehigh Valley Hospital – Cedar Crest

House Keeping

• Sign in and take name tags/lanyard
• Review and update the data managers listing
• Rest rooms
• Breakfast
• Lunch and snacks
• Silence all smart/flip phones/electronic devices. Please try to stay off

phone texting during meeting

• You can follow along with this presentation on your smart phone by
• pening meeting presentation on MACDM.org, goto meetings & Minutes,

select upcoming meeting for this session

• Drop name tags/lanyard in container in rear of room when leaving for the

day

Agenda Review

Start Time End Time Item Presenter 8:00 am 8:30 am Sign-in, *coffee/tee/water/snacks, networking All 8:30 am 8:35 am Agenda Review David Carey 8:35 am 8:50 am Attendees Survey, Location, Introduction All 8:50 am 9:05 am MACDM Updates David Carey 9:05 am 9:55 am STS (Society of Thoracic Surgeons) Annual Data Managers Conference David Carey 9:55 am 10:20 am STS Adult Cardiac – Updates David Carey 10:20 am 10:30 am STS Thoracic - Updates Sarah Knorr 10:30 am 10:45 am Break All 10:45 am 11:15 am Reduction of Vent Time in CABG -Ochsner Medical Center, New Orleans LA Sylvia Laudun 11:15 am 11:45 am Watchman Procedure - Boston Scientific Joe Whitaker 11:45 am 12:00 pm Break – Group Photo All 12:00 pm 12:40 pm *Lunch All 12:40 pm 1:00 pm NCDR ICD – NCDR call in, updates and CMS decision Caroline Morgan 1:00 pm 1:10 pm Open Discussion - NCDR ACTION/LAAO/TVT, STS Congenital/Dashboard Reporting All 1:10 pm 1:20 pm How to request additional help! David Carey 1:20 pm 2:10 pm AHA Get With the Guidelines New Web Site and Reports Crystal Glodek 2:10 pm 2:30 pm Break All 2:30 pm 2:55 pm NCDR Cath/PCI – New Cath/PCI version 5 form and open discussion David Carey 2:55 pm 3:00 pm Closing All

Attendees Survey

The following registries were selected as discussion interest from each MACDM meeting attendee:

Main Registries 2018 Spring 2018 Fall STS Adult Cardiac 75% 84% NCDR Cath/PCI 70% 66% AHA GWTG 33% 53% STS Thoracic 30% 32% NCDR ICD 40% 27% NCDR ACTION 15% 13% Other Registries of Interest NCDR TVT 4% 6% NCDR LAAO 4% 6% ACC ACD? 2% VQI 2%

Attendees Locations

Attendees In Introduction

Around the room introduction (hint, read off your name tag):

• First name
• Last name
• Hospital, organization or retired status
• City
• State
• *Let us know if this is your first regional data managers meeting!

Mission Objectives:

• Enhance the quality outcome collection and reporting of cardiovascular

procedures throughout the Mid-Atlantic Region.

• Improve outcome collection and reporting by using collaboration, networking and

knowledge transfer with other data managers throughout the mid-Atlantic hospitals.

• Increase any participating Mid-Atlantic data managers incite into current and

future STS (The Society of Thoracic Surgeons), NCDR (National Cardiovascular Data Registry), AHA (American Heart Association) changes communicated at their

• meetings. This will be communicated by attending Mid-Atlantic participating data

managers.

MACDM

MACDM (C (Continued)

MACDM (C (Continued)

MACDM (C (Continued)

Web site address: MACDM.org Data managers listing: Print or download - Click Attendees (Go to Bottom), see MACDM Data Managers List Rules to follow: No one in MACDM group is paid or compensated for any work No presenter is paid or compensated, other then free beverages/lunch No presenter can give political presentations What registries do we discuss: STS (The Society of Thoracic Surgeons) – Cardiac and Thoracic NCDR (National Cardiovascular Data Registry) – Cath/PCI AHA (American Heart Association) – GWTG Open discussion on TVT/LAAO/ACTION/ICD/Congenital or any other registry the group would like to discuss

MACDM (C (Continued)

Number of planned onsite meetings per year:

• We hold two onsite meetings per year to discuss major STS, NCDR and AHA registry form changes, web

site updates, reporting and important presentations from the most resent spring NCDR/fall STS annual meetings and any other sources.

• Spring MACDM meeting a few weeks after the NCDR annual conference.
• Fall MACDM meeting a few weeks after the STS annual conference.

How much does it cost to attend the meetings:

• The cost is either a $100 annual per hospital fee or a $25 per attendee/per meeting fee.
• If a hospital pays the annual $100 fee, they can send any number of staff to the meetings at no charge. To

get added to annual voucher, go to MACDM.org and click enroll. There is no charge and you will get a voucher and be put on the annual voucher mailing in December for next year.

• MACDM annual voucher will be sent out in December. Your MACDM # will drop the leading zeros going

forward to make it easier. Delaware Valley STS group status:

MACDM (C (Continued)

• Next NCDR Data Managers Conference March 13-15th 2019

Hyatt Regency, New Orleans, LA

• Next MACDM Data Managers Meetings:
• Spring - Tuesday, April 23rd, 2019 – Auditorium
• Fall – Wednesday, November 13th, 2019 – Kasych 6
• Next STS Data Managers Conference October 23-25th 2019

Marriott, New Orleans, LA

STS 2018 Annual Data Managers Conference

Conference (c (continued)

• STS Conference Data Managers Survey – Data interesting but only 29% attendees responded

STS Adult Cardiac Audit

STS Adult Cardiac Audit (c (continued)

STS Adult Cardiac Audit (c (continued)

STS Adult Cardiac Audit (c (continued)

STS Adult Cardiac Audit (c (continued)

STS Adult Cardiac Audit (c (continued)

STS Adult Cardiac Audit (c (continued)

STS Adult Cardiac (c (continued)

• Transferring Patient - STS wants you to send everything with patient to your

transfer hospital and vs versa.

These shaded slides taken from the Ohio Data Managers Presentation

STS Adult Cardiac (c (continued)

STS Adult Cardiac Audit (c (continued)

STS Adult Cardiac Audit (c (continued)

STS Adult Cardiac

• 30 Day Post-op Surgery Status - If a hospital has 30 day post-op surgery status of more than 2%

missing/Unknown of eligible patients, that hospital will NOT receive a star ratings for that reporting period.

• What does your hospital do to collect 30 day post-op surgery status?
• Every hospital has slightly different processes.
• One of our hospitals PA's calls each patient at 30 days and creates a EPIC telephone note.
• Other will look at EMR system. If they were admitted or if they had a follow-up visit, look for any mention of readmissions in any of

their hospitals. If neither, they say No.

• If there is no follow-up visit, they then try to call or contact. If they can't get any contact, they mark as Unknown.
• In last 2 years we had 1 unknown for 4 hospitals. Because we are more rural, they usually come back to one of our area hospital

services.

• Real Time Data Submission – New data submission allows near real time entry process. No sweat,

can use same old process going forward. Can submit data for past or present time.

• Operative Death Field – Much confusion about this field and long STS discussion. STS will not use

this field and determine this by the other data captured like date of death. This field will no longer be audited.

• Auditing Grace Period – No data will be audited from 7-1-2017 to 9-30-2017.

STS Adult Cardiac

• What fields will include and exclude procedures from CABG/AVR to
• ther?
• Version 2.9 new vendor screens and data submission - How’s it going?

STS Thoracic

• New thoracic version 2.4 live 7-1-2018
• Lobectomy for Lung Cancer – Public reporting started 2017
• Star Rating Lung Resection Comparison
• Most current 3 years of data
• Esophageal CA Resection Will Begin Public Reporting This Summer (probably)
• Will need to average 5 resections a year
• STS says only about 50% of participants will receive a rating.
• 5 Year Follow-up
• 5 year follow-up on only Lung Cancer and Esophageal Cancer patients – Starting from 1-1-2015
• procedures. 2015 year will be used until year 2020.
• Suggestion - Reach out to your COC (tumor or cancel registry) to get your follow-up update electronically
• Pull this data the 1st quarter of each year starting in 2017. Per STS, long term follow-up data should be

updated/reported with each harvest.

• Once a year send an Excel file with MRN to get a follow-up date and mortality date (status (alive/deceased) can be

determined from mortality date).

STS Thoracic (c (continued)

• Eddie Calls – Clifford Edwin Fonner – Has a monthly call for the thoracic

data managers the 3rd Wednesday of each month at 1:30 central time. For discussion of data collection issues and goes over responses to FAQ answered at their monthly STS meetings.

• The jeopardy section of the thoracic STS presentation did not go very

well and will probably not be on the recording of the STS meeting. It was not very pretty!

STS Reporting Dashboard

• After many attempts, STS will not agree to a web ex with our group to discuss

the STS Reporting Dashboard

• We will play a 5 minute copy of the STS Reporting Dashboard demo that will be

post in the future to the STS web site

15 Minute Break

Be back in 15

Reduction of f Ventilator Hours in Coronary ry Artery ry Bypass (C (CABG)

Reduction of f Vent Hours (c (continued)

Using a Multidisciplinary Approach for the Reduction of Ventilator Hours in Coronary Artery Bypass Graft (CABG)

November 27, 2018

ONE-Path Open Heart Surgery

Historical Data

▪ 2004

▪ Started entering data to the Adult Cardiac Surgery Database (ACSD) ▪ Attended first STS Data Managers Conference

▪ 2005 – Total Ventilation Hours (median) 15.4

▪ Reviewed extubation patterns for Elective Isolated CABG patient

▪ 1st Cases: 85% were extubated between 5:30 am – 7:30 am ▪ 2nd Cases: 88% were extubated between 5:30 am – 7:30 am

▪ Hurricane Katrina

▪ 2006 – Total Ventilation Hours (median) 14.0

▪ Developed SICU and Step-down Care Pathways for Adult Open Heart Surgery

Historical Data

▪ 2007 – Total Ventilation Hours (median) 11.9

▪ One Staff Surgeon for Adult Cardiac Heart Surgery

▪ 2008 – Total Ventilation Hours (median) 9.0

▪ Second Staff Surgeon for Adult Cardiac Heart Surgery

▪ 2009 – Total Ventilation Hours (median) 6.3 / STS 7.7

▪ Respiratory and ICU Intensive push for early extubation

▪ 2012 – Total Ventilation Hours (median) 14.0

▪ One Staff Surgeon resigned and two new Staff Surgeons hired for Adult Cardiac Heart Surgery

Watching data . . . . .

Ochsner Medical Center - New Orleans: Isolated CABG

2013 2014 2015 2016 2017 Q1

STS National Average 2017Q1

Number of cases 125 128 103 109 26 38,209 Total Ventilation Hours (Median) 8.7 9.4 9.6 8.1 9.0 18

STS: Total Ventilation Hours (Median)

6.4 6.1 6.0 5.9 5.8 5.8 Initial Ventilation <6 Hours 19.2% 21.4% 26.5% 32.1% 26.9% 53.4% Reintubation 0.8% 3.1% 7.8% 1.8% 3.8% 3.8% STS Adult Cardiac Surgery Data for Isolated CABG: 2013 through 2017 Q1

Low Performing Cardiac Surgery Programs High Performing Cardiac Surgery Programs

STS Value n=1108 Use of IMA 99.5%

97.9% 99.9%

7%

10%

Low Performing Cardiac Surgery Programs High Performing Cardiac Surgery Programs

STS Value 5.8

7%

10%

9.0 Total Vent Hrs (median) 3.8 Total Vent Hrs (median)

Pre-OnePathTotal Ventilator Time (median)

Pre ONE Path th Open Heart Surgery ry - Total l Ventila lator Hours (M (Median) for r Iso Isola lated CA CABG: 2016 – 2017 Q1

42 127.73

Pos

• st

t ON ONE Path th Op Open He Heart Sur Surgery: Total Ventilator Ho Hours s (M (Median) for

• r Isola

Isolated CA CABG BG: 2017 2017 Q2 Q2 – 2018 2018 Q3 Q3

43

Low Performing Cardiac Surgery Programs High Performing Cardiac Surgery Programs

STS 2018 Q2 Total Vent Hrs 5.4 0.0 Total Vent Hrs (median)

Total Ventilator Time (median)

Post ONE Path th Open Heart Surgery ry

46

Ochsner Medical Center - New Orleans: Isolated CABG

2016 2017 Q1 2017 Q3 2018 Q1 2018 Q3

STS National Average 2018 Q2

Number of cases 109 26 77 24 81 78,742 Total Ventilation Hours (Median) 8.1 9.0 7.8 0.0 0.0

STS: Total Ventilation Hours (Median)

5.9 5.8 5.7 5.5 *NA 5.4 Initial Ventilation <6 Hours 32.1% 26.9% 39.0% 75.0% 70.0% 57.7% Reintubation 1.8% 3.8% 7.8% 0.0% 3.7% 3.6% STS Adult Cardiac Surgery Data for Isolated CABG: 2016 through 2018 Q3 *STS 2018 Q3 will be available 1/30/2019

SICU Cost Saving fr from OR Ext xtubation

47

Number of Patients Extubated in OR Cost Savings Associated with OR Extubation

2016 $ - 2017 Q1 - Q3

8 $ 15,200.00

2017 Q4 - 2018 Q3

64 $ 121,600.00

Total cost savings since Kick Off for ONE Path = $136,800.00

* $1,900/day for ventilator rental

STS in New Orleans October 23-25, 2019

Watchman Procedure Presentation

Boston Scientific – Joe Whitaker

15 Minute Break and Group Photo

Group picture outside room in 15 minutes!

Half Hour Lunch Break

Lunch provided in back of room

NCDR IC ICD – NCDR Call In In

• Caroline Morgan
• ICD NCDR Registry updates
• ICD CMS registry decision

NCDR IC ICD - MACDM Group Open Discussion

ICD Open Discussion:

• How many hospitals still participate in ICD registry?
• If not, what do we have to do to fulfill the requirements?

Open Discussion Other Registries

• ACTION/LAAO/TVT/Congenital reporting?
• Congenital - new version 3 rolled out 1-1-2019 but as of yet no final

released form.

• 1 year status added (alive, dead, unknown and verification. A real concern

about the work needed to get this information but do the best you can.

• TVT – Public reporting target July 2020. Include 3 years data
• Any other discussion points?

How to Request Additional Help

*The minutes and hours per month are completely made up numbers used to complete this demonstration Procedure Counts 2017, 7 2017, 8 2017, 9 2017, 10 2017, 11 2017, 12 2018, 1 2018, 2 2018, 3 2018, 4 2018, 5 2018, 6 Grand Total CAB 28 17 19 17 15 23 21 13 20 14 27 21 235 AVR 3 3 6 3 9 6 8 2 4 4 8 3 59 AVR + CAB 2 3 3 4 3 4 1 1 2 4 27 AVR + MV Replace 2 1 1 1 1 1 7 MV Repair 1 1 3 1 1 2 1 1 2 13 MV Repair + CAB 1 1 2 MV Replace 3 2 1 3 1 3 2 3 18 MV Replace + CAB 1 1 3 1 1 2 1 10 Other 7 5 8 7 9 4 4 7 10 7 7 5 80 Grand Total 40 35 38 34 41 41 39 28 41 35 45 34 451 *Mean average minutes per

*Hours Per Month

CAB Procedures - *Minutes per procedure 160 75 45 51 45 40 61 56 35 53 37 72 56 627 AVR Procedures - *Minutes per procedure 180 9 9 18 9 27 18 24 6 12 12 24 9 177 AVR + CAB Procedures - *Minutes per procedure 180 6 9 9 12 9 12 3 3 6 12 81 AVR + MV Replace Procedures - *Minutes per procedure 180 6 3 3 3 3 3 21 MV Repair Procedures - *Minutes per procedure 180 3 3 9 3 3 6 3 3 6 39 MV Repair + CAB Procedures - *Minutes per procedure 180 3 3 6 MV Replace Procedures - *Minutes per procedure 180 9 6 3 9 3 9 6 9 54 MV Replace + CAB Procedures - *Minutes per procedure 180 3 3 9 3 3 6 3 30 Other Procedures - *Minutes per procedure 240 28 20 32 28 36 16 16 28 40 28 28 20 320 Validation - *Minutes per month 300 5 5 5 5 5 5 5 5 5 5 5 5 60 Reports, Quality and Queries - *Minutes per month 600 10 10 10 10 10 10 10 10 10 10 10 10 120 Other Responsibilities - *Minutes per month 600 10 10 10 10 10 10 10 10 10 10 10 10 120 Total Hours Per Month 143 129 141 128 152 144 139 112 151 132 158 125 1655 FTE's - Based on 20 working days a month and 7 hours per day 102% 92% 100% 92% 109% 103% 99% 80% 108% 95% 113% 89% 98%

AHA Get With the Guidelines New Web Site and Reports

Crystal Glodek, BSN, RN Director of Quality and Systems Improvement

Great Rivers Affiliate 1617 John F. Kennedy Blvd Suite 700 Philadelphia, Pa 19103 Crystal.Glodek@heart.org I www.heart.org P 215.575.5254 | Cell 215.779.5451

AHA Get With the Guidelines Data Deadline Dates

Once a year last quarter data deadline March 31st, of that following year (NCDR is April 17th). March 31st deadline is important for any annual awards based on prior years data. All other quarters can follow the NCDR Cath/PCI three other quarter deadlines.

20 Minute Break

Be back in 20

Cath/PCI Version 5

Optional Sections/Fields

Your hospital system must decide which of the following optional sections/fields to be completed! Section A. Demographics

• Asian, Native Hawaiian, Hispanic Ethnicity further breakdown. If not, select other options under each?

Section B. Episode of Care

• Admitting Provider’s Name, NPI – Fields – If you collect these, they will also need to be maintained in the NCDR registry?
• Attending Provider’s Name, NPI – Fields – If you collect these, they will also need to be maintained in the NCDR registry?
• Patient Restriction?
• Research Study – Only includes any NCDR research studies, not outside research studies

Section D. Pre-procedure information

• Seattle Angina Questionnaire (SAQ) - Section
• Rose Dyspnea Scale - Section

Section L. Discharge

• Discharge Provider’s Name, NPI - Fields – If you collect these, they will also need to be maintained in the NCDR registry?

Section M. Follow-up (30 day and 1 year)(entire section M optional) Out of roughly 1400 attending NCDR conference, roughly less than 12 were planning to submit follow-up

• Assessment Information
• Events
• Medications
• Seattle Angina Questionnaire (SAQ) Follow-up
• Rose Dyspnea Scale Follow-up

Cath/PCI Version 5 (c (continued)

• Version 4 is now retired. You can no longer resubmit any data prior to

4-1-2018.

• High Sensitivity Troponin – If you use this it is normally reported in

ng/L (liters). NCDR wants the ng/mL (which is 1000 to 1). If your lab reports High Sensitivity Troponin <6, then value as 5 otherwise rounding will make it 0.

• Are there any specific questions on the Cath/PCI version 5 form or

upload submission for 2nd quarter? Do you want to share your pain, suffering and knowledge?

• How is your vendor’s new version 5 working, once released?

Cath/PCI Version 5 (c (continued)

• NCDR is trying to link Cath/PCI Data to CMS Data for 30 day mortality

– If your not sending most PHI, not sure what they will do.

• Cath/PCI bleeding complication reduction – Big shift from PCI femoral

to radial. Projecting large savings on overnight stays due to less bleeding complications. Push to same day elective PCI’s.

• New NCDR dashboard reporting released for version 5, looks really

nice!

MACDM Closing

• Would anyone like to volunteer to present one registry. I will help you with creating presentation and

the presentation itself?

• Do we want a registry vender presentation (Lumedx, etc)
• Any future topics would you like to hear for fall/spring meeting?
• Any additional registry to discuss, specific fields discussion and process improvement?
• AHA New Web Site and report review project. We could partner with Ohio data managers and do

web ex’s to come up with any AHA GWTG site/report suggestions.

• Thanks again Lehigh Valley Hospital for hosting this meeting!
• Watch MACDM.org for meeting pictures and minutes to be announced!
• Please drop lanyard and name tag in container in rear of room when you leave