title: Decreasing process variation in the care of carotid endarterectomy patients.
abstract: Avoidable complications after successful carotid endarterectomy surgery typically occur in the immediate postoperative period; most of these complications are related to hemodynamic instability. At Saint Agnes Medical Center, process variation resulted from 22 anesthesiologists and 11 surgeons doing the same process 242 ways. We introduced a Post-Anesthesia Care Unit Carotid Order Set to standardize the process, drug sequence, and drug choices for postoperative carotid endarterectomy patients. Ongoing monitoring demonstrated that this reduction in process variability resulted in a lower complication rate for stroke and wound hematoma.
authors.affiliation: Saint Agnes Medical Center, Fresno, California, USA.
authors.forename: P
authors.initials: P
authors.lastname: Jordan
authors.forename: W
authors.initials: W
authors.lastname: Hadcock
authors.forename: C
authors.initials: C
authors.lastname: Beaulieu
authors.forename: S
authors.initials: S
authors.lastname: Kamada
authors.forename: J
authors.initials: J
authors.lastname: Vomacka
authors.forename: D
authors.initials: D
authors.lastname: Garrett
authors.forename: L
authors.initials: L
authors.lastname: Frye
mesh_terms: D000465:Algorithms; D002140:California; D019091:Critical Pathways; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000451:nursing*; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology; D019982:Organizational Case Studies; D016528:Postanesthesia Nursing / Q000592:standards*; D011183:Postoperative Complications / Q000188:drug therapy; D017064:Process Assessment, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D011997:Recovery Room / Q000592:standards* / Q000706:statistics & numerical data