Continous quality improvement of perfusion practice: the role of electronic data collection and statistical control charts

Abstract

In-hospital data collection may be used to improve the selection, operative techniques, and process of care for cardiac surgical patients. The aim of this report is to demonstrate the influence of the automated generation of quality indicators (QI) for cardiopulmonary bypass (CPB) and the implementation of a continuous quality improvement (CQI) programme on the CPB process of care. Adult patients undergoing CPB were divided into three consecutive groups: Group 1 (n = 363); no QI data feedback, Group 2 (n = 253); automated QI data feedback alone, and Group 3 (n = 363) data feedback and implementation of CQI. There were no significant differences in demographic, procedural or clinical outcomes for each group. Significant improvement, as determined by adherence to practice protocols and reduction in practice variation, was observed for cardiac index < 1.6 L/min/m2 (min), mean arterial pressure < 40 mmHg (min), venous saturation < 60% (min), arterial blood temperature of > 37.5 degrees C (min), minimum pCO2 (mmHg), maximum pCO2 (mmHg), and minimum pO2 (mmHg). There was no change in the minimum haemoglobin (g/dl) on bypass. Automated generation of QI resulted in improved adherence to process of care guidelines, highlighting the potential of electronic data collection. This technique is optimised in a CQI programme, utilising statistical control charts for data interpretation.