title: Results of the establishment of an organizational model in a cardiovascular surgery service.
abstract: OBJECTIVE
  Increasing complexity of patients referred to cardiac surgery demands more effective heart centers, in order to maintain the same quality. The aim of this study is to examine the short-term effect of adoption of an organizational model on surgical outcomes.
  
  
  METHODS
  From January 2006 to June 2007, 367 consecutive adult patients underwent cardiovascular surgery. Pre-, intra- and postoperative data were prospectively collected and transferred to an institutional database. Organizational model was established in August 2006, and based on integrated multiprofessional team work patient-centered, evidence-based medicine with standardized patient care and personal conflict management. The outcomes studied were hospital mortality and combined adverse events (death, stroke, acute myocardial infarction and acute renal failure), by using multivariate logistic regression analysis.
  
  
  RESULTS
  After establishment of such model, there was reduction of hospital mortality (from 12% to 3.6%, relative risk= 0.3; P=0.003) and combined events (from 22% to 15%, relative risk=0.68; P=0.11). Operations performed previously to the model were independently associated with higher mortality (OR=2.5; P=0.04), adjusted to preoperative characteristics and Euroscore risk stratification system. Other predictors of mortality were age > 65 years (OR=6.36; 95%CI 2.57 - 17.21; P<0.0001) and cardiopulmonary bypass time > 145 minutes (OR=8.57; 95%CI 3.55 - 21.99; P<0.0001).
  
  
  CONCLUSIONS
  Marked improvements in surgical outcomes depend on development of cardiac surgery centers based on organizational models similar to the model proposed in this study.
authors.affiliation: Cardiology Institute of DistritoFederal, Cardiology University Foundation, Brasília, DF, Brazil. atikf@mac.com
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Atik
authors.forename: Maria Fernanda M A
authors.initials: MF
authors.lastname: Garcia
authors.forename: Linda Maria
authors.initials: LM
authors.lastname: Santos
authors.forename: Renato B
authors.initials: RB
authors.lastname: Chaves
authors.forename: Cristiano N
authors.initials: CN
authors.lastname: Faber
authors.forename: Ricardo B
authors.initials: RB
authors.lastname: Corso
authors.forename: Nubia W
authors.initials: NW
authors.lastname: Vieira
authors.forename: Luiz Fernando
authors.initials: LF
authors.lastname: Caneo
mesh_terms: D000328:Adult; D016507:Cardiology Service, Hospital / Q000458:organization & administration*; D002318:Cardiovascular Diseases / Q000401:mortality / Q000601:surgery*; D004812:Epidemiologic Methods; D019317:Evidence-Based Medicine; D005112:Extracorporeal Circulation / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007400:Interprofessional Relations; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D018802:Patient-Centered Care; D011182:Postoperative Care; D011300:Preoperative Care; D016896:Treatment Outcome