title: Cardiovascular-radical outcome method is effective in complex congenital cardiac lesions.
abstract: BACKGROUND
  The cardiovascular-radical outcome method is a proactive process of patient care that uses standard critical pathway methodology to reduce negative variation while encouraging positive variation to accelerate recovery. Its effectiveness in patients with complex congenital heart disease is explored.
  
  
  METHODS
  Two hundred fourteen consecutive patients with congenital heart disease were cared for using the cardiovascular radical outcome method. Age ranged from 2 days to 19 years (median age, 3 years). Cardiovascular radical outcome method data were compared with the pathway plan data for each patient.
  
  
  RESULTS
  Survival was 99% (211 patients) with an overall reduction in stay of 156 days (0.74 day/patient) (p < 0.0001). Only 10 patients (5%) exceeded the pathway plan; 201 (95%) reached the planned length of stay (critical pathway method), and 127 patients (60%) had a shorter length of stay than expected by the critical pathway method. One hundred forty-eight patients (70%), including 95 (64%) with more complex conditions, had a length of stay of 3 days and 18% achieved a 2-day length of stay, the maximal response. The process was most effective in the most complex groups, although preoperative comorbidities influenced outcomes. Outcome assessment demonstrated minimal morbidity and excellent family satisfaction.
  
  
  CONCLUSIONS
  The radical outcome method is effective in reducing the length of stay of patients with complex congenital heart disease. The power is in the process rather than the plan, and the method provides optimal patient care and family satisfaction.
authors.affiliation: California Pacific Medical Center, San Francisco 94115, USA.
authors.forename: K
authors.initials: K
authors.lastname: Turley
authors.forename: M
authors.initials: M
authors.lastname: Tyndall
authors.forename: K M
authors.initials: KM
authors.lastname: Turley
authors.forename: C
authors.initials: C
authors.lastname: Roge
authors.forename: M
authors.initials: M
authors.lastname: Cooper
authors.forename: H
authors.initials: H
authors.lastname: Tarnoff
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001017:Aortic Coarctation / Q000601:surgery; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D019091:Critical Pathways; D004374:Ductus Arteriosus, Patent / Q000601:surgery; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011651:Pulmonary Artery / Q000601:surgery; D015996:Survival Rate; D013771:Tetralogy of Fallot / Q000601:surgery; D016896:Treatment Outcome