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Quality initiatives in Cardiothoracic Surgery

In 2017, the UK Cardiac Surgery team performed more than 700 cardiac surgical procedures, more than had been done in any given year since the institution of UK’s cardiac surgical programs.

More impressive than this record number, however, was the observed-to-expected mortality ratio of 0.66.

Scores considered “acceptable” by the Society of Thoracic Surgeons, which created the database, generally range from 1.3-0.85, with lower scores being better. This STS database is considered the gold standard by which quality in cardiac surgery programs is measured.

“The fact that UK’s score is so much better than the scores at comparable institutions implies that this is not just a ‘glitch,’ but a true dramatic improvement in the quality of the work being done at UK,” said Michael Sekela, MD, Chief of the Division of Cardiothoracic Surgery.

And the result of years of hard work within the program.

In 2014, the UK Cardiac Surgery team began an intensive effort to make improvements to its quality metrics, which were already well within the acceptable range.

“We felt we could do better,” said Sekela.

So the team created a plan broken down in to the phases of cardiac surgical care: preoperative evaluation, intraoperative management, post-op intensive care management, post-intensive care in-hospital management, and early home management. Each phase was addressed separately and improvements made at every phase.

As a final step, the team created a 72-page protocol of care covering the time from the moment the patient entered the hospital until they left was created. The document is made available to every staff member playing a role in cardiac patient care ensuring consistent, high-quality care for every patient.

The dramatic improvement in scores over just three years is a monumental achievement for the UK program, and a boon for its patients.

See more stories from 2018 State of the Heart