The Sixth National Adult Cardiac Surgical Database – “Demonstrating Quality”

Posted on July 30, 2009. Filed under: Cardiol / Cardiothor Surg, Clin Governance / Risk Mgmt / Quality | Tags: |

The Sixth National Adult Cardiac Surgical Database – “Demonstrating Quality”
Compiled by:             Professor Sir Bruce Keogh, Mr Ben Bridgewater, Dr Robin Kinsman & Dr Peter Walton
512 page – A4 Hardback            ISBN 1-903968-23-2    Price: £100.00 (plus p&p)

“The sixth edition in the series of ‘National Adult Cardiac Surgical Database Reports’ from the Society for Cardiothoracic Surgery in Great Britain & Ireland, is the most comprehensive documentation of current cardiac practice ever published. This latest Report analyses over 400,000 patient records collected over a 15–year period (1994–2008), subjecting the specialty of cardiac surgery to an unrivalled degree of scrutiny. This latest edition expands upon the previous reports and as well as including coronary artery bypass surgery, the 2009 Report features detailed and comprehensive information regarding aortic valve surgery, mitral valve surgery, major aortic surgery and multiple valve and the other miscellaneous cardiac operations. The Report contains analyses that show:

* Significant improvements in survival for most cardiac surgical procedures, despite increasing complexity of case mix and an increasing proportion of elderly patients undergoing heart surgery.
* Variations in the types of surgery undertaken for various disorders between hospitals, marked differences in volumes and significant variations in equity of access to potentially life-saving treatments by geographical region.

In addition to these detailed procedure-specific analyses, the report examines the methodological issues around predicting operative risk and adjusting for case mix, which are both essential if comparisons are to be made about differing outcomes between hospitals or surgeons. Furthermore, the mortality outcomes are also featured for all hospitals, which performed surgery for all cardiac surgery, isolated coronary artery bypass surgery and isolated aortic valve surgery, using appropriate risk-adjustment methodology.

The Report clearly justifies the decision to openly scrutinise and publish cardiac surgical results in the United Kingdom and will rightly be hailed as an example to other specialties around the world wishing to undertake clinical audit.”

An article about this clinical audit process:

Ben Bridgewater on why funding clinical audit is essential
30 July 2009 | By Ben Bridgewater

“Observing clinical outcomes and ensuring they enrich the NHS’s wealth of data is essential so audit must be fully backed by national funding, leadership and IT

“Observation affects reality” – the theory that the act of studying a process alters the outcome is well proven. In a healthcare system where the primary strategies for driving improvement have been target setting and researching new treatments, does this mean an opportunity has been missed? Can healthcare be improved simply by clinicians properly observing current practice?

Cardiac surgeons set about collecting simple data in 1977 but in recent years they have developed a professionally led audit database that benchmarks mortality outcomes. All units report and the database now includes outcomes on over 400,000 operations.

The sixth Society of Cardiothoracic Surgery national database report published this week, the first for five years, is a comprehensive analysis of this data, and includes examination of trends, risks and outcomes of patients undergoing adult cardiac surgery.

The results suggest that the very process of collecting, analysing and feeding back data to units has markedly driven improvements.”   … continues on the website

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