Improving Indicators in a Brazilian Hospital Through Quality-Improvement Programs Based on STS Database Reports

Silva, Pedro Gabriel Melo de Barros e; Baruzzi, Antônio Claudio do Amaral; Ramos, Denise Louzada; Okada, Mariana Yumi; Garcia, José Carlos Teixeira; Cardoso, Fernanda de Andrade; Rodrigues, Marcelo Jamus; Furlan, Valter

doi:10.5935/1678-9741.20150075

Pedro Gabriel Melo de Barros e Silva

Amil Chronic Diseases Management Unit (Totalcor), São Paulo, SP, Brazil - Brazilian Clinical Research Institute (BCRI), São Paulo, SP, Brazil

Antônio Claudio do Amaral Baruzzi

Amil Chronic Diseases Management Unit (Totalcor), São Paulo, SP, Brazil

Denise Louzada Ramos

Amil Chronic Diseases Management Unit (Totalcor), São Paulo, SP, Brazil - Brazilian Clinical Research Institute (BCRI), São Paulo, SP, Brazil

Mariana Yumi Okada

Amil Chronic Diseases Management Unit (Totalcor), São Paulo, SP, Brazil - Brazilian Clinical Research Institute (BCRI), São Paulo, SP, Brazil

José Carlos Teixeira Garcia

Amil Chronic Diseases Management Unit (Totalcor), São Paulo, SP, Brazil - Brazilian Clinical Research Institute (BCRI), São Paulo, SP, Brazil

Fernanda de Andrade Cardoso

Amil Chronic Diseases Management Unit (Totalcor), São Paulo, SP, Brazil

Marcelo Jamus Rodrigues

Amil Chronic Diseases Management Unit (Totalcor), São Paulo, SP, Brazil

Valter Furlan

Amil Chronic Diseases Management Unit (Totalcor), São Paulo, SP, Brazil

Correspondence Address: Pedro Gabriel Melo de Barros e Silva, Totalcor Hospital, Alameda Santos, 764 - Cerqueira César, São Paulo, SP, Brazil - Zip code: 01418-100. E-mail: drpedrobarros80@gmail.com

Tables (4)

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Abbreviations, acronyms & symbols CABG = Coronary artery bypass grafting ICU = Intensive care unit LOS = Length of stay MV = Mechanical ventilation OR = Odds Ratio QI = Quality improvement STS = Society of Thoracic Surgeons

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Table 1
Domains of the STS Database report.

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Table 2
Results of the quality-improvements targets.

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Authors' roles & responsibilities PGMBS Analysis/interpretation of data; statistical analysis; final approval of the manuscript; conception and design; implementation of projects/experiments; manuscript writing or critical review of its content ACAB Analysis/interpretation of data; final approval of the manuscript; manuscript writing or critical review of its content DLR Analysis/interpretation of data; final approval of the manuscript MYO Analysis/interpretation of data; final approval of the manuscript JCTG Analysis/interpretation of data; final approval of the manuscript FAC Analysis/interpretation of data; final approval of the manuscript; implementation of projects/experiments MJR Analysis/interpretation of data; final approval of the manuscript; implementation of projects/experiments VF Analysis/interpretation of data; final approval of the manuscript; conception and design; manuscript writing or critical review of its content

Abbreviations, acronyms & symbols
CABG	= Coronary artery bypass grafting
ICU	= Intensive care unit
LOS	= Length of stay
MV	= Mechanical ventilation
OR	= Odds Ratio
QI	= Quality improvement
STS	= Society of Thoracic Surgeons

Domain	Description
Avoidance of operative mortality	Proportion of patients (risk-adjusted) who do not experience operative mortality
Avoidance of operative mortality	Operative mortality is defined as death during the same hospitalization as surgery or after discharge but within 30 days of the procedure
Avoidance of major morbidity	Major morbidity is defined as having at least one of the following adverse outcomes: 1) reoperations for any reason; 2) renal failure; 3) deep sternal wound infection; 4) prolonged ventilation/ intubation; 5) cerebrovascular accident/permanent stroke
Proportion of patients (risk-adjusted) who do not experience any major morbidity
Use of internal mammary artery (IMA)	Proportion of first-time CABG patients who receive at least one IMA graft without prior CABG surgery or documented contraindication for IMA use (subclavian stenosis, previous cardiac or thoracic surgery, previous mediastinal radiation, an emergent salvage procedure or no LAD disease)
Use of all evidence-based perioperative medications	Proportion of patients who receive all required perioperative medications: 1) preoperative beta blockade therapy; 2) discharge anti-platelet medication; 3) discharge beta blockade therapy; and 4) discharge anti-lipid medication. Note: the discharge medications were not required for patients who died prior to discharge
Overall composite	A participant's overall composite performance score is calculated as a weighted* average of the domain-specific estimates

	Pre-QI program (n=519)	Post- QI program (n=428)	P-value
Time on MV (hours)	10.4	7.1	< 0.01
Initial ventilation < 6 hours	52%	85%	< 0.01
Reintubation	2.9%	2.1%	0.53
O/E MV > 24 hours (95% CI)	0.45 (0.24 - 0.66)	0.24 (0.04 - 0.45)	ns
LOS in ICU	64.9	54.2	< 0.01
Readmission to ICU	4.4%	2.8%	0.22
O/E LOS < 6 days (95% CI)	0.80 (0.70-0.90)	1.03 (0.92 - 1.14)	0.02
Use of IMA	98.2%	99%	0.40
Use of EBT	87.4%	95.3%	< 0.01
Avoidance of operative mortality	98.50%	98.60%	0.99
Avoidance of major morbidity	91.10%	95.10%	0.02
O/E mortality ratio (95% CI)	1.5 (0.97 - 2.03)	1.7 (1.0- 2.4)	ns

Authors' roles & responsibilities
PGMBS	Analysis/interpretation of data; statistical analysis; final approval of the manuscript; conception and design; implementation of projects/experiments; manuscript writing or critical review of its content
ACAB	Analysis/interpretation of data; final approval of the manuscript; manuscript writing or critical review of its content
DLR	Analysis/interpretation of data; final approval of the manuscript
MYO	Analysis/interpretation of data; final approval of the manuscript
JCTG	Analysis/interpretation of data; final approval of the manuscript
FAC	Analysis/interpretation of data; final approval of the manuscript; implementation of projects/experiments
MJR	Analysis/interpretation of data; final approval of the manuscript; implementation of projects/experiments
VF	Analysis/interpretation of data; final approval of the manuscript; conception and design; manuscript writing or critical review of its content

[1] Correspondence Address: Pedro Gabriel Melo de Barros e Silva, Totalcor Hospital, Alameda Santos, 764 - Cerqueira César, São Paulo, SP, Brazil - Zip code: 01418-100. E-mail: drpedrobarros80@gmail.com

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Improving Indicators in a Brazilian Hospital Through Quality-Improvement Programs Based on STS Database Reports

ABSTRACT

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION: