Excellent results coming in for project funded jointly by VPSA Facility Engagement and Physician Led Quality Improvement Initiatives

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The hard work is paying off for Dr. Kelly Mayson and her multi-disciplinary team. Their project, Pre-operative optimization prior to major oncology surgery as a component of Enhanced Recovery After Surgery, is seeing some great preliminary results.

“Over the past year we have seen a reduction in the incidence of anemia in gynaecology oncology and radical cystectomy patients presenting for major abdominal surgery based on our work,” said Dr. Mayson. “For gynaecology oncology, the incidence of anemia has decreased from 43.2 to 32.8 per cent and for radical cystectomy it has decreased from 40.6 to 25 per cent. This is due to a significant increase in the referrals to the Perioperative Blood Management Program (PBMP) and the treatment of iron deficiency anemia. Baseline data demonstrated that the percentage of appropriate referrals to PBMP for radical cystectomy patients increased from 43 to 78.1 per cent.”

The project team is currently reviewing length of stays and complication rates for each surgical procedure to look at the effect of this pilot optimization prior to surgery program.

The Specialist Services Committee recently agreed to sponsor a provincial surgical optimization collaborative. There will be approximately five pilot sites initially (including VGH) that will continue their work over the next 12 months. There is a plan to expand to additional sites throughout the province in September 2019, with funding for approximately another nine to 12 months. This province-wide collaborative will be structured similarly to the BC ERAS Collaborative initiative.

“We are also reviewing the effectiveness of improved glycemic control in the ERAS population; however, there are many more data points to assess and that information likely won’t be available until end of December,” added Dr. Mayson. “Fifteen per cent of our surgical population is diabetic, and a significant percentage of non-diabetic patients develop hyperglycemia in the perioperative period due to stress of surgery. We have started to screen all patients and have seen that at least 10 per cent of patients are pre-diabetic or have unrecognized diabetes.”

The VGH Preadmission Clinic is currently undergoing a review and the project team is exploring introducing nutritional counselling, frailty screening and a physiotherapy/kinesiology-prescribed exercise program in the future.

Dr. Mayson submitted the project’s preliminary data as an abstract to the BCPSQC Quality Forum and it was recently accepted for a rapid-fire presentation in February 2019.

Congratulations to Dr. Mayson and all those involved with this important project.

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