Skip to main content
Article
Reduction in coronary artery bypass grafting surgery mortality and morbidity during a 3-year multicenter quality improvement project.
The Journal of thoracic and cardiovascular surgery
  • Neil Worrall, Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA
  • James Brevig, Providence Regional Medical Center, Everett, WA
  • Ruyun Jin, Center for Cardiovascular Analytics, Research, and Data Science; Providence St Joseph Heart Institute, Portland, OR
  • Tyler J Gluckman, Providence Heart and Vascular Institute, Portland, OR, USA.
  • Robert Hunter, Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA
  • Matthew Ducsik, Providence St Joseph Heart Institute, Renton, WA
  • Braden Batkoff, Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA
  • Gary Grunkemeier, Providence St Joseph Heart Institute, Renton, Wash
Document Type
Article
Publication Date
5-17-2019
Keywords
  • cards
Disciplines
Abstract

OBJECTIVE: Risk-adjusted operative mortality is a key quality measure for isolated coronary artery bypass grafting. Through a multicenter quality improvement initiative, we sought to improve this measure at 14 surgical programs within a large and geographically dispersed health care system.

METHODS: Observed mortality and combined mortality/morbidity rates for isolated coronary artery bypass grafting were collected from January 2014 to June 2017. Expected mortality and mortality/morbidity rates were determined using the Society of Thoracic Surgeons risk models. The observed/expected ratios during the baseline (2014) and final 12-month outcome period were compared. The quality improvement intervention was multifaceted and surgeon led, and consisted of (1) regular sharing of unblinded data, (2) standardized quality improvement processes, (3) regular system-wide quality improvement meetings, (4) annual observed/expected mortality targets, (5) identification of underperforming institutions and creation of nonpunitive quality improvement action plans, and (6) implementation of checklists to drive perioperative care standardization.

RESULTS: The observed/expected ratio of mortality was 1.19 during the baseline period and decreased to 0.59 for the outcome period (P = .004) without a change in expected mortality or case volume. The observed/expected ratio decreased for mortality/morbidity, and mortality without antecedent morbidity was almost eliminated.

CONCLUSIONS: A significant and clinically meaningful 50% reduction in the observed/expected ratio for isolated coronary artery bypass grafting mortality was observed during a multifaceted quality improvement initiative across a large multicenter health care system. Morbidity also decreased. Keys to success included surgeon leadership and engagement, frequent unblinded data sharing, development of standardized quality improvement processes, improvement and standardization of care delivery, setting of quality improvement targets, and a shared vision for improved patient outcomes.

Area of Special Interest
Cardiovascular (Heart)
Specialty/Research Institute
Cardiology
Citation Information
Neil Worrall, James Brevig, Ruyun Jin, Tyler J Gluckman, et al.. "Reduction in coronary artery bypass grafting surgery mortality and morbidity during a 3-year multicenter quality improvement project." The Journal of thoracic and cardiovascular surgery (2019)
Available at: http://works.bepress.com/gary-grunkemeier/241/