title: Reducing costs and length of stay and improving efficiency and quality of care in cardiac surgery.
abstract: BACKGROUND
  The present era of health care places major emphasis on significantly reducing cost and resource utilization while maintaining quality of care and patient satisfaction. Clinicians are being challenged to 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.
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: L H
authors.initials: LH
authors.lastname: Cohn
authors.forename: D
authors.initials: D
authors.lastname: Rosborough
authors.forename: J
authors.initials: J
authors.lastname: Fernandez
mesh_terms: D000288:Administrative Personnel / Q000458:organization & administration; D001900:Boston; D003363:Cost Control; D004526:Efficiency; D006801:Humans; D007902:Length of Stay; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D013503:Surgery Department, Hospital / Q000458:organization & administration; D013903:Thoracic Surgery / Q000191:economics* / Q000592:standards*; D019616:Thoracic Surgical Procedures / Q000191:economics* / Q000592:standards*