Monitoring the rate of re-exploration for excessive bleeding after cardiac surgery in adults.
BACKGROUND
The monitoring of adverse events in clinical care can be an important part of quality assurance. There is little evidence on the monitoring of re-exploration after cardiac surgery.


OBJECTIVE
To apply statistical monitoring techniques to the rate of re-exploration for excessive bleeding in adult patients undergoing cardiac surgery procedures using cardiopulmonary bypass at Geelong Hospital, Victoria, Australia, between 1997 and 2003.


METHODS
Shewhart charts, moving average plots and cumulative sum (CUSUM) charts were used to demonstrate changes in the rate of re-exploration over time.


RESULTS
A CUSUM chart was used retrospectively at a time of perceived deteriorating clinical outcomes in patients of the cardiac surgery service. At this time, an intervention aimed at reducing the re-exploration rate was performed, and subsequent CUSUM charts indicated an improvement in this rate. The CUSUM chart has become an important part of the quality feedback of clinical care outcomes within the Anaesthesia & Pain Management unit of Geelong Hospital.


CONCLUSIONS
Statistical monitoring techniques for quality assurance can identify important changes in clinical performance, and their adoption by clinicians is recommended.
Wolfe
Rory
R
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Bolsin
Stephen
S
Colson
Mark
M
Stow
Peter
P
D000328:Adult; D000368:Aged; D016507:Cardiology Service, Hospital / Q000592:standards; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D019106:Postoperative Hemorrhage / Q000453:epidemiology* / Q000601:surgery; D019984:Quality Indicators, Health Care; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D013503:Surgery Department, Hospital / Q000592:standards*; D014739:Victoria / Q000453:epidemiology