Evaluation of the impact of a quality improvement program and intensivist-directed icu team on mortality after cardiac surgery

摘要

Objective: Quality improvement is an important pursuit for critical care teams. Design: The authors performed an observational cohort study with historic control. Setting: Eight-bed cardiac surgery ICU in a tertiary university hospital. Participants: A total of 4,866 patients undergoing cardiac surgery over a 6-year period between January 2005 and December 2010. Interventions: In this study, the influence of the introduction of a quality improvement program under the supervision of a newly appointed intensivist on patient outcomes after cardiac surgery was evaluated. Patients were further divided into three 2-year periods: Period I, 2005-2006, before appointment of an intensivist; Period II, 2007-2008, after appointment of an intensivist and initial introduction of a quality improvement program; and Period III, 2009-2010, after implementation of the program and introduction of Critical Care Information Systems. Measurements and Main Results: There were 1,633, 1,690, and 1,543 patients in each period, respectively. There was no significant difference in the severity of patient illness between the groups. Unadjusted in-hospital mortality decreased from 6.37% (104 patients) in Period I to 4.32% (73 patients) and 3.3% (51 patients) in Periods II and III, respectively (p< 0.01). Conclusions: Appointment of an intensivist-directed team model and introduction of quality improvement interventions were associated with decreased mortality after cardiac surgery.