Increasing the value of cardiac care: the Dartmouth approach.
A cardiac services team at Dartmouth-Hitchcock Medical Center (DHMC) launched multiple efforts to improve the quality and value of their services. The team developed a critical path for coronary artery bypass grafting (CABG) and tracked important clinical outcomes, such as mortality rates and wound complications. The team also studied the patient's view of the process. Staff used focus groups and surveys to distill the "voice of the customer" into six quality characteristics and developed methods to better involve patients in clinical decision making and evaluation of treatment efficacy.


RESULTS
CABG mortality declined from 5.7 percent in 1992 to 2.7 percent in 1994, 16 months after the critical path was developed. Mean total intubation time for patients following open-heart surgery was reduced from 22 hours to 14 hours. Median postoperative length of stay decreased from seven days to six for elective CABG patients. The number of patients discharged in five days or less increased from 20 percent to 40 percent. Readmission to the hospital following discharge remained stable, despite the shorter length of stay.
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Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.
Niles
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Schults
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Wolf
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Robb
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Nelson
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D016507:Cardiology Service, Hospital / Q000592:standards*; D002985:Clinical Protocols; D001026:Coronary Artery Bypass / Q000401:mortality / Q000592:standards*; D006745:Hospital Bed Capacity, 300 to 499; D017052:Hospital Mortality; D015285:Hospital-Patient Relations; D006801:Humans; D009513:New Hampshire / Q000453:epidemiology