Using database information in your clinical practice.
BACKGROUND
Clinical database information is in wide demand, but it is not always used to its full potential. Clinicians must learn to be the experts and to assert leadership in the use of their own data.


METHODS
Clinical databases provide unique perspectives on the full process of care for a heterogeneous population of patients. They focus beyond individual providers, to their interaction within a complex system of care. Exploring questions that arise from this data can identify system issues, which are invisible to individual practitioners or specialties using other traditional review methods.


RESULTS
Clinical database information helped our hospital staff identify problems in their approach to a small subset of high risk coronary bypass patients. Multiple system changes resulted in a dramatic reduction in mortality. Collateral impact on all care reduced overall mortality from 4.5% to below 2%.


CONCLUSIONS
The greatest opportunities for improvement in patient care often lie in the areas where specialties or teams interface, eg, in overlapping or transferring care. The whole system of care for each patient must be optimized, not just the individual specialty components. Clinical database information provides a way to evaluate and improve the overall process and results of the broader system of patient care.
Dziuban
S W
SW
St. Peter's Hospital, Albany, New York, USA. sdziuban@albany.net
D001026:Coronary Artery Bypass / Q000401:mortality*; D016208:Databases, Factual; D017052:Hospital Mortality; D006801:Humans; D010348:Patient Care Team / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018570:Risk Assessment; D016019:Survival Analysis; D014481:United States