Maintaining Quality in Lower Volume Cardiac Surgery: A Blueprint From a Military Program. (July 2018)

• Record Type: Journal Article
• Authors: Antevil, Jared L.; Mullenix, Philip S.; Reoma, Junewai L.; Massimiano, Paul S.; Lough, Frederick C.; Elster, Eric A.
• Is Part Of: American journal of medical quality. Volume 33:Number 4(2018)
• Page Start: 426
• Page End: 433
• Publication Date: 2018-07
• Subjects: quality of health care -- heart diseases -- cardiac surgical procedures -- physicians' practice patterns; Medical care -- Quality control -- Periodicals; Medical care -- Evaluation -- Periodicals; Medical care -- Utilization review -- Periodicals; Medical care -- United States -- Periodicals; 362.1
• DOI: 10.1177/1062860617747729
• Languages: English
• ISSNs: 1062-8606

Abstract

Although there is a clear volume–outcome relationship in the field of cardiac surgery, the existence of high-performing programs with relatively low case volumes is well established. This report describes the programmatic and institutional processes in place at a lower volume cardiac surgery center in a US military hospital, which have been executed to optimally leverage available resources in the delivery of exemplary patient care. By implementing a highly collaborative practice, rigorous outcomes review, evidence-based standardized care pathways, consistent attending surgeon oversight for care delivery, careful case selection, and a mechanism for support from highly experienced outside cardiac surgeons, the cardiac surgery program at the authors' institution delivers care on par with its higher volume counterparts. A review of these practices and available supporting evidence may provide a model for other programs seeking success in this setting.