Evaluation of the Impact of a Quality Improvement Program and Intensivist-Directed ICU Team on Mortality After Cardiac Surgery

ObjectiveQuality improvement is an important pursuit for critical care teams.DesignThe authors performed an observational cohort study with historic control.SettingEight-bed cardiac surgery ICU in a tertiary university hospital.ParticipantsA total of 4,866 patients undergoing cardiac surgery over a 6-year period between January 2005 and December 2010.InterventionsIn 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 ResultsThere 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).ConclusionsAppointment of an intensivist-directed team model and introduction of quality improvement interventions were associated with decreased mortality after cardiac surgery.