AB086. SOH26AB_0451. Aspirin administration within 6 hours post coronary artery bypass graft (CABG) surgery: improving outcomes through a closed-loop audit

Background: As electronic patient record systems (ERS) become more prevalent, there is a risk that automation may perpetuate poor clinical practices. The American Heart Association 2021 guidelines provide a level 1 a recommendation in favour of aspirin administration to patients within 6 hours post-coronary artery bypass graft (CABG) surgery. Previous studies have demonstrated low compliance with these recommendations. The objective is to assess pre- and post-intervention compliance with international guidelines for aspirin administration within 6 hours post-CABG surgery.

Methods: A retrospective review of the most recent 20 patients undergoing isolated CABG at Cork University Hospital was conducted using ERS data to determine aspirin administration timing post-CABG. Following the initial audit, an intervention took place, which included educational sessions for healthcare staff and modifications to the ERS post-operative order set and schedule. A post-intervention audit was conducted in December 2024, followed by a re-audit in September 2025.

Results: The initial audit demonstrated 0% compliance with 6-hour aspirin administration, as all patients received aspirin at 06:00 the following morning per the default order-set. Post-intervention compliance improved to 65%, and re-audit data demonstrated further improvement to 80%.

Conclusions: This audit demonstrates that ERS can obscure sub-optimal clinical practices if not appropriately configured, highlighting the importance of correct data input. However, simple interventions, including staff education and ERS modification, led to substantial improvement in guideline compliance. Furthermore, the re-audit improvements demonstrate that ERS modifications can be a powerful tool for sustaining long-term improvements that maintain an evidence-based clinical practise.

Keywords: Aspirin; cardiac surgery; coronary artery bypass grafting (CABG); electronic health records; quality improvement