Implementation of an Evidence-based Protocol to Increase the Use of Goal-directed Hemodynamic Therapy

Purpose

This quality improvement project aimed to increase goal-directed hemodynamic therapy (GHDT) utilization in adult patients undergoing coronary artery bypass grafts (CABG) by implementing an evidence-based intraoperative GDHT protocol.

Design

A quality improvement project.

Methods

The team implemented a training bundle to raise awareness of complications associated with IOH, educate providers about GDHT benefits, and explain how to incorporate the protocol to guide intraoperative hemodynamic management. The team performed retrospective chart reviews to determine baseline and post-implementation GDHT protocol utilization and IOH incidence.

Findings

After receiving the education and protocol implementation, anesthesia providers began using the GDHT monitors on 100% of CABG procedures at this facility. A total of 60 patient charts were reviewed. Average cumulative hypotensive time decreased by 16.8%, from 26.37 minutes to 21.93 minutes (P = .375, 95% CI [-5.49, 13.35]).

Conclusions

Although there was no significant reduction in IOH, the training bundle and team support increased anesthesia providers' interest in using GDHT monitors. This led to a significant rise in its utilization. A future project is planned to expand the GDHT monitors and protocol to the entire operating room. Post-anesthesia care and intensive care units desiring to increase GDHT use may benefit from similar projects.