title: When things go wrong: the impact of being a statistical outlier in publicly reported coronary artery bypass graft surgery mortality data.
abstract: The public reporting of hospital quality and safety data is a growing phenomenon. Yet there are few reports of the effects of publicly reported data on individual organizations, particularly when the data show worse than expected performance. In this article, our hospital's response to having a mortality rate from coronary artery bypass graft surgery that was significantly higher than other programs in the Commonwealth of Massachusetts is reported. The data caused suspension of elective cardiac surgery at the institution, and an independent review of the program was undertaken. The effects of the suspension and publication of mortality data on quality and patient safety, the residency training program in cardiothoracic surgery, and the financial performance of the hospital are described. Several lessons were learned that may be of value to other health care organizations that experience a public crisis in clinical quality.
authors.affiliation: UMass Memorial Medical Center, Worcester, Massachusetts 01655, USA. ettingew@ummhc.org
authors.forename: Walter H
authors.initials: WH
authors.lastname: Ettinger
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Hylka
authors.forename: Robert A
authors.initials: RA
authors.lastname: Phillips
authors.forename: Lynn H
authors.initials: LH
authors.lastname: Harrison
authors.forename: Jay A
authors.initials: JA
authors.lastname: Cyr
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Sussman
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000401:mortality*; D017558:Elective Surgical Procedures / Q000401:mortality; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D016311:Outliers, DRG; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D019984:Quality Indicators, Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration*