Elsevier

The Annals of Thoracic Surgery

Volume 58, Issue 6, December 1994, Pages 1845-1851
The Annals of Thoracic Surgery

The veterans affairs continuous improvement in cardiac surgery study,☆☆

https://doi.org/10.1016/0003-4975(94)91725-6Get rights and content

Abstract

The Department of Veterans Affairs Cardiac Surgery Consultants Committee is responsible for reviewing the quality of cardiac surgical treatment at the 43 Veterans Affairs cardiac surgical centers where these procedures are performed. It does so by reviewing both the unadjusted and risk-adjusted operative mortality data and the incidence of perioperative complications. These data are reviewed by the committee semiannually, and the overall summary and hospital-specific data are shared with the individual cardiac surgical program directors. Paper audits and site visits are performed when indicated by increased unadjusted and risk-adjusted operative mortality. Constructive criticism is shared with the program director and medical center administration. The relative risk of death for numerous patient risk factors has been estimated, and is now used in prospective clinical decision making. During the 7-year period that risk-adjusted outcomes have been utilized, there has been an overall significant reduction in the observed-to-expected operative mortality ratio. Although many factors could have contributed to this, including continually improving surgical techniques, it is also likely that part of this improvement has occurred because of the continuous feedback of these quality improvement data to our Cardiothoracic surgeons and cardiologists.

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Presented at the National Symposium on Using Outcomes Data to Improve Clinical Practice: Building on Models From Cardiac Surgery, Keystone, CO, June 6–7, 1994.

☆☆

This research has been supported by the Department of Veterans Affairs Health Services Research and Development Servke and the Offices of Quality Management and Clinical Affairs, Washington, DC.

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