title: Continuous quality improvement decreases length of stay and adverse events: a case study in an interventional cardiology program.
abstract: A study was performed to assess the effectiveness of continuous quality improvement in achieving a better quality of care for patients undergoing coronary interventions. Increasing utilization of new coronary interventional devices has incurred a higher incidence of complications, prolonged hospital stay, and related costs. Using a clinical information system, we adopted continuous quality improvement to control the incidence of complications and postprocedural length of stay. Multiple regression analysis and a matched case-control study were performed to detect complications related to postprocedural length of stay and their causes among 342 patients. The results led to the modification of the postprocedural heparin anticoagulation protocol, which was followed by the introduction of a ticlopidine-based poststent anticoagulation regimen. Two sequential groups of patients (n = 261, n = 266) were selected to compare postprocedural length of stay and frequency of complications with those for the first group. Adjustments were made for patients and procedural characteristics through stratification and multiple regression methods. Blood transfusion was the most important predictor of prolonged hospital stay (partial R2 = 0.26, P < 0.01). A high level of postprocedural anticoagulation and intracoronary stent use were significantly associated with blood transfusion (P = 0.01, P = 0.02, respectively). The comparison among the three groups showed that heparin protocol change reduced only postprocedural length of stay (P < 0.001) for patients without stents, whereas the stent change in anticoagulation protocol significantly reduced both transfusion and hospital stay for patients with stents (P < 0.001, P < 0.05, respectively). Continuous quality improvement based on clinical information is promising to control both complications and hospital costs. Physician involvement is necessary throughout the process.
authors.affiliation: Harvard School of Public Health, Boston, MA, USA.
authors.forename: H
authors.initials: H
authors.lastname: Hashimoto
authors.forename: R M
authors.initials: RM
authors.lastname: Bohmer
authors.forename: L C
authors.initials: LC
authors.lastname: Harrell
authors.forename: I F
authors.initials: IF
authors.lastname: Palacios
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001900:Boston; D006348:Cardiac Surgical Procedures / Q000191:economics / Q000592:standards*; D016507:Cardiology Service, Hospital / Q000191:economics / Q000592:standards*; D003363:Cost Control; D005260:Female; D017721:Hospital Costs; D006751:Hospital Information Systems; D006773:Hospitals, Municipal / Q000191:economics / Q000592:standards; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D012044:Regression Analysis; D017749:Total Quality Management; D065227:Transfusion Reaction