The researchers have focused on PSI 11, which measures the rate of preventable, postoperative respiratory failure for patients undergoing elective surgeries, as well as PSI 12, which evaluates the rate of perioperative pulmonary embolism or deep vein thrombosis. Dr. Eikermann and his team – including Lab Chief Dr. Maira Rudolph, Critical Care Fellow Dr. Omid Azimaraghi, Director of Digital Innovation Dr. Ling Zhang, and Critical Care Quality Assurance Director Dr. Michael Kiyatkin – are collaborating with Rafael Ruiz of the Network Performance Group as well as MHS Senior Vice President Dr. Andrew Racine, Medical Director for Clinical Documentation Dr. Carolyn Bauer, and Senior Director of the Montefiore Center for Performance Improvement Dr. Fran Ganz-Lord. Together, the multidisciplinary group has utilized Montefiore’s digital health database to redefine how elective surgery is coded within Epic. In order to reduce the incidence of postoperative respiratory failure, the researchers established and implemented new definitions for elective versus emergent surgeries. The correct classification of these surgeries is key for evaluating respiratory failure events. For example, if a patient has a cancer diagnosis and they undergo a surgery related to the cancer diagnosis, the surgery is considered non-elective. Similarly, if a patient has a heart attack or sepsis and subsequently needs surgery, the surgery is non-elective because they have an acute disease. Previously, higher-risk urgent surgeries were frequently mislabeled as elective surgeries – an error that strongly influenced how the metric of postoperative respiratory failure is evaluated and rated.

“It is exciting to see that the Anesthesiology Digital Health Laboratory is able to create processes that can be implemented into clinical practice in a few weeks,” Dr. Eikermann said. “This requires the strong support by our senior hospital leadership who appreciate our contributions to further strengthen our reputation.”

Similarly, Dr. Kiyatkin, who was selected to be a 2023 MHS Performance Improvement Fellow, worked with Assistant Director of Analytics Ankeeta Shukla to develop a series of interventions to reduce the risk of respiratory failure. First, they created a specific definition for preventable respiratory failure in accordance with consensus definitions from the Society for Thoracic Surgeons, Agency for Healthcare Research and Quality, and the National Surgical Quality Improvement Program. In addition, Dr. Kiyatkin is looking to integrate into clinical practice the use of a machine learning model that he developed over the last three years that could predict which patients are at a high risk of respiratory failure.

“We as anesthesiologists are involved in a lot of aspects of the perioperative period, and one of the tenets on which our specialty was founded is patient safety,” Dr. Kiyatkin said. “It's a natural fit to be working on these quality improvement metrics, and we have made a huge contribution in this case, together with the multidisciplinary team.”

To reduce the incidence of PSI 12 – the rate of perioperative pulmonary embolism or deep vein thrombosis – the Digital Health Lab is creating a different prediction model to determine which patients are at an increased risk of a thromboembolic event. In addition, the researchers are analyzing chemoprophylaxis of deep vein thrombosis to improve patient outcomes in this area. Anesthesiologist and Intensivist Dr. Christopher Tam has recently been selected as the cochampion – with Dr. Ganz-Lord – to lead these process improvement efforts. The team will develop guidelines on administering chemoprophylaxis in surgical patients to decrease the adverse event of deep vein thrombosis.

The Digital Health Lab team will continue working with the MHS Network Performance Group and other multidisciplinary colleagues to continue to reduce the incidence of both postoperative respiratory failure and thrombosis in 2024.

“Since we have shown successfully how to add value to diagnosis and prevention of postoperative respiratory failure, we are excited to embrace a new challenge,” Dr. Eikermann said. “In collaboration with Dr. Fran Ganz-Lord, Dr. Peter Shamamian, and others, we will improve the quality of perioperative thromboembolic prophylaxis and its diagnosis documentation.”