HOW A NEW-YORK CARDIAC-SURGERY PROGRAM USES OUTCOMES DATA

In New York State, a risk-adjusted outcomes system has been used by the Department of Health to monitor all cardiac operations since January 1989. Hospital-specific and physician-specific results are published annually, In this report we describe the experience of one hospital in New York State whose results showed a higher than expected surgical mortality. Staff: reactions were initially skeptical, and case reviews found no quality-of-care problems. However, a different approach using statistical analysis of the detailed case-specific outcomes data was more revealing. The excess mortality was localized to patients having high-acuity, emergency coronary artery bypass grafting, particularly those who had suffered a preoperative acute myocardial infarction less than 6 hours before, those who were in shock, or those who were in a hemodynamically unstable condition. The staff responded with a focused effort to optimize the management of these patients, resulting in zero mortality for emergency coronary artery bypass grafting during the following year. In the process, staff: from all departments joined together in a more collaborative approach to the cardiac surgery program. Outcomes data can be useful for effecting program improvement if comparable norms and open access for flexible analysis are available.