Dictionary.com defines synergy as the interaction or cooperation of two or more organizations, substances, or other agents to produce a combined effect greater than the sum of their separate effects. Synonyms are offered as “cooperative interaction” and “combined effort." Merriam Webster defines synergy as a “combined action or operation involving a mutually advantageous conjunction or compatibility of distinct business participants or elements.” Never before has synergy been more important in cardiovascular medicine. With public reporting so widely available, and information systems so intelligently advanced, we are seeing the number of data repositories exponentially increase. We are being scored for our processes, reimbursed for our outcomes, and penalized for our adverse events. The time has come to unite in cardiovascular medicine and to ensure that the high quality of our care is a result of synergistic efforts among multiple disciplines. It is incumbent upon us to ensure that our data are being accurately represented in a multidisciplinary and risk-adjusted fashion.
If you practice in Michigan, surgical outcomes may be represented in the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative. In Virginia, the Virginia Cardiac Surgery Quality Intitiative seeks to improve quality of care and reduce costs in the state; while New York boasts one of the earliest publicly resported database systems. Ideally there would be a universal, richly populated repository for cardiovascular data that would consider patient risk-adjustment along with institutional factors. But this single product does not exist and it can be quite confusing and burdensome to adjudicate the existing entities. The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery database comes close to an ideal reporting system. Note, however, that upon inception, most of these quality collaboratives did not include anesthesiologists in their leadership structures. They lacked relevant representation of anesthesiology practice. Anesthesiology variables were glaringly absent from the datasets, reflecting a shared culture of either ambivalence or ignorance. The concept that anesthesiology had any impact on short- or long-term outcomes other than a lost airway or a drug allergy was heresy.
For that matter, anesthesiologists did not want any liability for long-term outcomes such as kidney injury, cognitive impairment, or wound infection, despite fully mastering the domains of blood product and drug administration. Want it or not, accepting liability as a member of the healthcare delivery team and taking responsibility for improving patient outcomes is now a vital component to our sustainability in the current climate. Expanding our critical roles and participating in quality improvement through collection of data will be invaluable toward promoting the success of the cardiac team. The recent addition of anesthesiology variables to the STS database in the form of the Adult Cardiac Surgery Anesthesiology Module has moved us one step in the direction of team accountability. Visit the SCA/STS Database for more information.
Interestingly ahead of its time, the Northern New England Cardiovascular Disease Study Group was founded in 1987, and is a highly functional synergistic group. Its leadership is inclusive of cardiovascular anesthesiologists along with surgeons, cardiologists, and nurses, and its data collection form reflects this inclusivity.
So How is the SCA Creating Synergy?
Anesthesiologists are a vital part of the cardiac surgical TEAM (“Together Everyone Achieves More”). We are affirming our role and commitment to the team through interdisciplinary collaboration, intersocietal relationships, and joint ventures. This has been a gradual process, and I will share with you a few of the recent endeavors.
SCA is working with STS and AmSECT in constructing best practices in perfusion management. Last year, the first of this group of guidelines was published on temperature management in cardiopulmonary bypass. This major collaboration complements the fact that SCA and STS have always partnered in presenting panels at each other’s meetings. STS and SCA now share representation on each other’s respective database and quality committees. The American Association for Thoracic Surgery (AATS) is hosting its first “Patient Safety Course” in Boston, June 24–25. Dr. Jake Abernathy and other anesthesiologists are actively represented on the faculty and program.
The American Society of Echocardiography (ASE), in conjunction with SCA, recently conducted the Interventional Echocardiography and Decision Making in Structural Heart Disease Symposium at the SCA Echo Week. This meeting was extremely successful. In November 2016, The American Heart Association (AHA) Annual Meeting “Sessions” will host its first AHA-SCA Panel with presentations surrounding controversies in aortic valve stenosis management. This panel is a part of the Cardiovascular Surgery and Anesthesia Council, a council that was recently renamed to bear our name. In previous president’s messages, I have mentioned the work that our Clinical Practice Improvement projects are undertaking. These high-level interdisciplinary groups, composed of anesthesiologists, surgeons, cardiologists, and internists, are creating educational materials to teach best practices for common clinical problems such as atrial fibrillation, neurologic dysfunction, and patient blood management.
Taking lessons from the “tough as steel” business leader Andrew Carnegie, he emphasizes the importance of the TEAM. "Teamwork is the ability to work together toward a common vision. The ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results."
Henry Ford said it best: "If everyone is moving forward together, then success takes care of itself."