Real-time performance improvement through real-time performance assessment in congenital heart surgery

Anthony Rossi
Director of the Cardiac Intensive Care Program, Miami Children’s Hospital
Miami, USA

Performance improvement is achieved only through the measurement of objective indicators of a group’s process or procedure. Maintaining excellence and improving performance in a cardiac surgical program requires accurate and repeated objective measurement of a program’s performance as a whole, and also at the individual patient level. Real-time performance assessment may allow a program to rapidly adapt to changing conditions to maintain or improve outcomes. Utilizing proven techniques of performance improvement and embracing principles of Edward Tufte in using graphical design to display quantitative data, outcomes in a cardiac surgical program showed marked improvement in a short period of time.
　In July of 2001, a point of care testing device (i-Stat, Abbott) was introduced to the cardiac ICU to objectively measure the performance of individual patients as they progressed through their intensive care course. The blood lactate data would be used to guide the individual patient through their hospital course. In February 2002, Miami Children’s Hospital helped develop software (i-Rounds, Teges) which allowed the team to track the ultimate outcome of each patient admitted to the cardiac program in real-time. The data was entered as the official hospital medical record and was stored as a sequel server database. Outcomes were then made available on the internet, in real-time, for internal review by team members or external review by the public, via the domain www.pediatricheartsurgery.com. The data was available in both tabular and graphic form and risk adjusted for age and complexity. This data was used to measure the cardiac team’s performance as a whole.
　There is uniform agreement that performance improvement can only be achieved through the use of accurate and timely performance assessment. We achieved performance improvement in a congenital heart program by measuring outcomes of individual patients and the program’s performance as a whole, in real-time and displaying the data in information rich graphics.