Improved total quality by monitoring of a cardiothoracic unit. Medical, administrative and economic data followed for 9 years.

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Åberg, TorkelUmeå universitet,Kirurgi (författare)

Improved total quality by monitoring of a cardiothoracic unit. Medical, administrative and economic data followed for 9 years.

Artikel/kapitelEngelska2004

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Oxford University Press,2004
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LIBRIS-ID:oai:DiVA.org:umu-22708
https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-22708URI
https://doi.org/10.1016/S1569-9293(03)00218-4DOI

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Språk:engelska
Sammanfattning på:engelska

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To describe monitoring of a cardio-thoracic department from a total quality aspect point of view and to follow the development over 9 years. During the time period 1994-2002 a total of 10,828 cardio-thoracic operations were performed. Capacity, demographic, risk, quality, outcome and economic data were prospectively collected in various registries and analysed. Mean (and median) age increased from 64.2 to 65.3 (66-67). Patients above 70 years increased from 33.6 to 38.7% and above 80 from 2.9 to 5.5%. Operative mortality was unchanged over the time periods at slightly over 2%, with 1-year mortality 6-7%. Mortality for primary, elective coronary artery bypass grafting was 0.26% during the last 3 years. The rate of postoperative complications remained unchanged or decreased with few exceptions: Patients with postoperative confusion increased from 5.0 to 8.1% and patients with a need for face mask ventilation increased from 2.4 to 4.0%. Mean postoperative ventilation time was unchanged at around 22 h, whereas the median decreased from 9.5 to 5.3 h. The workload created by elderly patients was especially noticeable in the intensive care unit (ICU) as both number of postoperative deviations and ICU hours increased as a function of age. Cost per operation decreased by 11%. Total medical rationalisation was higher as salaries increased over time. Mean length of stay decreased by 3 days. Hospital staff hours per operation decreased whereas hospital staff hours per patient hour increased. Physician cost per operation was unchanged. Patient, staff and referring physician satisfaction was high. Several areas for improvement have been found. Monitoring and general feedback of total quality factors has shown itself a powerful tool to detect and follow large and subtle changes in the practice of cardio-thoracic surgery. Most followed factors show improvement in spite of an increase in mean and median age. Several areas may be defined where further development might decrease the trauma to the patient. Aiming at a total quality and patient safety system, monitoring is an essential prerequisite.

Ämnesord och genrebeteckningar

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Kardiologi hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Cardiac and Cardiovascular Systems hsv//eng
MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Health Care Service and Management, Health Policy and Services and Health Economy hsv//eng
monitoring
cardiac surgery
time trends
mortality
morbidity
costs

Biuppslag (personer, institutioner, konferenser, titlar ...)

Hentschel, JanUmeå universitet,Kirurgi (författare)
Umeå universitetKirurgi (creator_code:org_t)

Sammanhörande titlar

Ingår i:Interactive Cardiovascular and Thoracic Surgery: Oxford University Press3:1, s. 33-401569-92931569-9285

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Av författaren/redakt...: Åberg, Torkel; Hentschel, Jan

Om ämnet

MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kardiologi

MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Hälsovetenskap; och Hälso och sjukvå ...

Artiklar i publikationen: Interactive Card ...

Av lärosätet: Umeå universitet

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