Reducing costs and length of stay and improving efficiency and quality of care in cardiac surgery

Background. The present era of health care places major emphasis on significantly reducing cast and resource utilization while maintaining quality of cart and patient satisfaction, Clinicians are being challenged eo achieve this within the framework of a patient subset that is increasing in severity of disease and risk-adjusted mortality. The Brigham and Women's Cardiac Surgical Services Management Group was formed in 1987 to help accomplish these goals. Methods. The principles we have followed involve protocols and people. The multidisciplinary group includes the chiefs of cardiac surgery and anesthesia, chief residents, physician assistants, perfusionists, intensive care unit nursing personnel, and case managers. Weekly meetings address every aspect of problems arising in the cardiac surgical service; separate weekly morbidity and mortality conferences are held. The Care Coordination Team establishes and monitors clinical pathways and recommends ways of improving all aspects of the service through a process of daily review on an individual patient basis. Results. The volume of cardiac surgery at Brigham and Women's Hospital has increased steadily. The length of stay overall has decreased about 15%, and similarly, cost and total charges have also decreased. In addition, patient satisfaction has increased to a level of about 95%. Conclusions. The goals of cost-containment with improved patient care and outcome are possible through the collaborative efforts of representatives of all the personnel involved in cardiac care, as well as leadership by the surgical faculty. (C) 1997 by The Society of Thoracic Surgeons.