J Clin Outcomes Manage
A clinical pathway to improve surgical risk assessment and use of perioperative beta blockade in noncardiac surgery patients
Robinson RL, Rogers LQ, Todd CY, Bussing RC
Abstract Objective: To assess the impact of a clinical pathway for operative risk assessment designed to increase the appropriate use of perioperative b blockers. Design: Retrospective cohort study. Patients and setting: Charts of patients who underwent outpatient perioperative risk assessment at a university primary care clinic 7 days or less before elective surgery were selected and reviewed. Data were obtained from 100 preintervention and 61 postintervention patients. Measures: Rates of documentation of surgical risk factors, documentation of risk for perioperative cardiac events, and appropriate use of perioperative b-blocker therapy. Results: The postintervention group had higher rates of documentation of surgical risk factors (79% versus 59%; P = 0.01) and cardiac event risk factors (82% versus 36%; P < 0.001) compared with the preintervention group. Among the 53 patients who met the pathway criteria for b-blocker therapy, those in the postintervention group were more likely to have b-blocker therapy initiated at the time of the risk-assessment visit (42% versus 0% preintervention; P < 0.001) and to receive perioperative b-blocker therapy overall (73% versus 41% preintervention; P = 0.013). Conclusion: This clinical pathway improves documentation of surgical risk and recognition of patient risk factors for perioperative cardiac events and increases appropriate use of perioperative b blockers in patients who undergo elective noncardiac surgery.
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