Can We Take Continuous Quality Improvement to the Next Level?

The Society of Thoracic Surgeons' National Cardiac Database (NCD), which is housed and managed at the Duke Clinical Research Institute, has set the standard for effective professional society–sponsored clinical registries. Nearly 90% of US hospitals performing cardiac surgery participate in the NCD. In addition to accruing mortality and morbidity outcomes information from >3.6 million cardiac surgery patients since 1989, the NCD has been used to develop risk models for cardiac surgery procedures that are widely used to assess the appropriateness of surgical intervention. The NCD also has been used for continuous quality improvement (CQI) efforts when tracking process measures of care in cardiac surgery patients, such as the use of the internal mammary artery in coronary artery bypass grafting (CABG) procedures, or the use of preoperative β-blockade therapy.1Article see p 39This present report clearly demonstrates the effectiveness of a straightforward CQI intervention, ensuring that patients received appropriate discharge medications after CABG.2 Some would dispute the authors' characterization of this intervention as “low intensity.” In fact, it is a serious intervention, because coronary atherosclerosis is a lifetime illness. Established coronary artery disease requires effective secondary prevention measures after bypass surgery to sustain cardiac improvement and lasting health. The authors accurately describe the occasion of discharge instruction for CABG patients as a teachable moment. Unfortunately, in our compartmentalized healthcare delivery system, some cardiac patients do not receive a full lesson plan on how to deal with their coronary …