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The Annals of Thoracic Surgery, Vol 58, 1845-1851, Copyright © 1994 by The Society of Thoracic Surgeons
FL Grover, RR Johnson, AL Shroyer, G Marshall and KE Hammermeister
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.
ARTICLES
The Veterans Affairs Continuous Improvement in Cardiac Surgery Study
Division of Cardiology, University of Colorado Health Sciences Center, Denver.
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