A real-time rapid cycle process improvement tool for accelerated quality improvement in coronary artery bypass...

We report a custom-designed visual feedback tool integrated into a comprehensive quality improvement (QI) program to drive accelerated, real-time advances in coronary artery bypass grafting (CABG) surgery.

The Society of Thoracic Surgeons (STS) risk profiles of 977 consecutive patients who underwent CABG between January 1, 2021, and December 31, 2024 risk profiles were analyzed. For 2021-2022, the mortality observed-to-expected ratio (O/E) was 2.5. In 2023, we started a real-time, rapid cycle process improvement program. We designed a QI tool to calculate in real time the O/Es for death, stroke, renal failure, prolonged ventilation, reoperation, deep sternal wound infection, prolonged length of stay, and failure of left internal mammary artery (LIMA) use or medication compliance. We developed a final composite score in which we assigned 80% to mortality, 7% to LIMA use, 3% to medications, and 10% to nonfatal STS adverse outcomes as a rough estimate of the STS 3-star CABG construct. For a final composite grade, we assigned "good" (O/E < 0.65), "fair" (O/E = 0.65-1.0), or "poor" (O/E > 1.0) for each adverse outcome.

The CABG mortality O/E improved from 1.5 in 2021-2022 to 0.25 in 2023-2024 (P < .0001; z = 327,991). The final composite O/E for 2023-2024 was 0.55 ("good"). This resulted in a final composite grade of "good," coinciding with our 3-star STS status for isolated CABG.

Our custom-designed QI tool enabled rapid improvement of our CABG outcomes (P < .0001). This report is unique because it uses the publicly available STS risk calculator for real-time rapid cycle process improvement, integrated into a comprehensive QI program.