Page 31 - An Innovation Spirit ...

trailblazer

How the Peter Munk Cardiac It’s a busy Tuesday morning at
Centre Innovation Fund is Toronto’s Peter Munk Cardiac Centre
(PMCC). ¶ A middle-aged male patient
improving patient outcomes, is guided slowly into the rounded
one project at a time opening of a CT scanner in the Joint
Department of Medical Imaging
by Shelley White (JDMI), while technicians on the other
side of the glass study glowing images
Dr. Thomas of the chest cavity on monitors. Nurses
Lindsay, closely monitor the progress of the
centre, hospital’s most acutely ill patients in the
Coronary Intensive Care Unit (CICU),
Division Head while family members anxiously wait
of Vascular on couches located around the corner to
Surgery, see their loved ones. A group of medical
performing residents and international fellows,
life-saving along with a staff doctor, cluster in the
aneurysm hallway of the Cardiovascular Intensive
surgery. Care Unit (CVICU), discussing the
care of an elderly patient who had
Winter 2016 open heart surgery the day before.

In the operating room (OR) down the hall, it’s that critical
time after a bypass operation, when surgeons must determine
whether or not a patient will require a blood transfusion.

It can be tricky thing to predict. Traditionally, doctors had
to make that determination by eyeballing the situation, and
if a patient looked “wet” (that is, still bleeding), he or she
would be given blood. But today, the OR team is utilizing
a leading-edge testing process that is saving blood, saving
money and improving patient outcomes. It’s just one
of the pioneering innovations that have been generated
through the PMCC’s trailblazing Innovation Fund.

The blood-conservation project was conceived three years
ago by Dr. Keyvan Karkouti, Deputy-Anesthesiologist-in-
Chief at Toronto General Hospital. It works in a two-part
approach: First, during heart surgery, a nurse takes a sample
of the patient’s blood and tests it in a machine (in a down-
the-hall lab) that immediately indicates how well the blood is
coagulating. Second, surgeons pack sponges around the heart
and then weigh the sponges after exactly five minutes. If the
sponges weigh more than 60 grams, the coagulation tests
dictate if a patient needs blood. No guesswork required.

Since adopting the blood-conservation project, “our red blood
cell transfusions have dropped by about 20 per cent, our plasma
transfusions have dropped by 60 per cent and platelets by about 40
per cent,” says Dr. Karkouti. (It’s also saved the hospital more than
$1-million this year.) “But, more importantly, it’s changing how we
manage bleeding patients, with improvement in patient outcomes.”

Dr. Karkouti says kidney damage has been reduced, as
well as the need for re-exploration after surgery. “Before the
program, 7 per cent of patients would finish surgery, go to
the [Intensive Care Unit] and then either start bleeding or
continue to bleed and would have to come back to the OR.
That’s dropped in half, from 7 to 3 per cent,” he says.

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