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Increasing the value of cardiac care: the Dartmouth approach
W C Nugent1, N W Niles, W Schults
1Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.
Insights
Implementing a critical pathway for coronary artery bypass grafting (CABG) significantly improved patient outcomes. This initiative reduced mortality rates and shortened hospital stays, enhancing the quality of cardiac services.
Area of Science:
- Cardiovascular Surgery
- Healthcare Quality Improvement
Background:
- Cardiac services at Dartmouth-Hitchcock Medical Center (DHMC) initiated quality and value improvement efforts.
- Focus on coronary artery bypass grafting (CABG) services to optimize patient care and outcomes.
Purpose of the Study:
- To implement a critical pathway for CABG to enhance clinical outcomes and patient experience.
- To integrate patient perspectives into clinical decision-making and treatment evaluation.
Main Methods:
- Development and implementation of a critical pathway for CABG.
- Tracking of clinical outcomes including mortality and wound complications.
- Utilizing focus groups and surveys to capture patient feedback ('voice of the customer').
Main Results:
- Coronary artery bypass grafting (CABG) mortality decreased from 5.7% to 2.7% post-implementation.
- Mean intubation time reduced from 22 to 14 hours; median length of stay decreased from 7 to 6 days for elective CABG.
- Proportion of patients discharged within 5 days doubled from 20% to 40% with stable readmission rates.
Conclusions:
- The critical pathway approach demonstrably improved key clinical outcomes for CABG patients.
- Patient-centered methods enhanced involvement in care, contributing to service quality.
- DHMC's integrated strategy successfully improved efficiency and effectiveness in cardiac surgery.
Unlabelled:
A cardiac services team at Dartmouth-Hitchcock Medical Center (DHMC) launched multiple efforts to improve the quality and value of their services. The team developed a critical path for coronary artery bypass grafting (CABG) and tracked important clinical outcomes, such as mortality rates and wound complications. The team also studied the patient's view of the process. Staff used focus groups and surveys to distill the "voice of the customer" into six quality characteristics and developed methods to better involve patients in clinical decision making and evaluation of treatment efficacy.
Results:
CABG mortality declined from 5.7 percent in 1992 to 2.7 percent in 1994, 16 months after the critical path was developed. Mean total intubation time for patients following open-heart surgery was reduced from 22 hours to 14 hours. Median postoperative length of stay decreased from seven days to six for elective CABG patients. The number of patients discharged in five days or less increased from 20 percent to 40 percent. Readmission to the hospital following discharge remained stable, despite the shorter length of stay.