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Surgery Grand Rounds

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Grand Rounds

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Educational Schedule

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Educational Schedule - March 2014 (PDF)

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Outcomes Research in the Surgical Intensive Care Unit

By Eric J. Ley, MD
Director, Surgical Intensive Care Units
Director, Surgical Critical Care Residency Program

Outcomes research seeks to evaluate the benefit of particular healthcare practices and interventions. We conduct critical care outcomes research at Cedars-Sinai to determine which interventions are most effective.

Our findings may challenge clinicians, researchers and health systems leaders to assess the impact of specific healthcare services. By deconstructing care provided for critically ill patients and then linking specific interventions to their outcomes, we develop better ways to improve the quality of care we provide.

For clinicians and patients, outcomes research offers evidence about benefits, risks and results of treatments. Here are examples of outcomes research from the Surgical Intensive Care Unit:

  • Do you find your patients in the SICU receive less intravenous maintenance fluid? Post-operative fluid therapy has been a mainstay for care of the critically ill surgical patient. We reviewed a cohort of critically ill acute care surgery patients and determined achieving a negative fluid status early during the SICU admission was associated with a nearly 40 percent reduction in the risk for post-operative complications. So we minimize the maintenance fluids whenever possible.
  • Does it seem like we check the vancomycin trough levels more frequently? We found in our critically ill trauma population that 34.6 percent of patients had a vancomycin trough level that was too high, and this was an independent predictor for acute kidney injury and mortality, so we instituted a protocol to minimize supratherapeutic trough levels. We judiciously dose vancomycin and send many more vancomycin trough levels.
  • Do you question the need to screen patients for methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE)? In a review of our SICU population, 5 percent screened positive for MRSA and 9 percent screened positive for VRE. Colonization allows us to better titrate antibiotics. We found a negative screen results in a high specificity and negative predictive value for the development of MRSA or VRE hospital-acquired infection. This means that empiric treatment for MRSA or VRE infection may be unnecessary when the associated screen is negative.
  • Are we treating fewer patients for suspected heparin-induced thrombocytopenia (HIT)? We determined the false positive rate for HIT using our previous criteria was 81 percent. We established that a PF4 equal to or greater than 2.0 OD is the point at which the rate of true positives for HIT equals the rate of false positives. So we may delay treatment for lower PF4 levels. This outcomes research has decreased our use of argatroban in case of false positive HIT.

Through the collaboration of many teams of clinicians and researchers, we can achieve the highest quality of care in the surgical critical care unit. Please chat with a surgical intensivist if you are interested in our latest outcomes research.