Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

is it possible to extubated the majority of heart surgery patients in operating room and would this improve outcomes and cost savings

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

we are presently extubabating our patients in OR and feel its is a major advantage for patient and cost savings for hospital, we have developed a major new way to administer anesthesia, which allows the patient to awake at end of case and remain stable, we use very little narcotic and use biss monitor to determine depth of anesthesia, so pt wakes up at end of case easily with no recall, we also use marcaine rib blocks to control pain, we don't use swan ganz cath or NG tubes, patient returns to cardiac icu awake, pain free, and without wide swings in blood pressure, translate into shorter icu and hospital stays, major cost savings and more importantly patients do better, this is a much better approach compared to standard way of doing heart surgery

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

this technique can be used on any heart surgery patient

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

no

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

benefit are huge, major cost savings, and much better patient outcomes

Describe any health-related risks, side effects, or harms that you are concerned about.

a very small % require incubation, 1 %

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Cardiovascular disease, including stroke and hypertension

AHRQ Priority Populations

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

we need to get this technique out to the hospitals and surgeons who perform heart operations, again it is a major cost savings and patients do better

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

we have slowly developed this technique over 10 years and feel it is important to get it out to everyone involved in caring for cardiac patients, especially in these times of cost containment

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

change is always slow and difficult but this is an obvious major advantage

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

if we document the valeue of this approach then we can make it a best practice guideline

Describe the timeframe in which an answer to your question is needed.

we have the data with the society of thoracic surgeons we need help putting it all together

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

if we document the valeue of this approach then we can make it a best practice guideline

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program

at our yearly society meeting