title: Journey to top performance: a multipronged quality improvement approach to reducing cardiac surgery mortality.
abstract: BACKGROUND
  In 2006, leadership at Long Island Jewish Medical Center (New Hyde Park, New York) noted significantly higher cardiac surgery mortality rates for isolated valve and valve/coronary artery bypass graft procedures compared to the New York State Department of Health's Cardiac Surgery Reporting System statewide average.
  
  
  METHODS
  Long Island Jewish Medical Center, a 583-bed nonprofit, tertiary care teaching hospital, is one of the clinical and academic hubs of North Shore-LIJ Health System. Senior leadership launched an evaluation of the cardiac surgery program to determine why cardiac surgery mortality rates were higher than expected. As a result, the cardiac surgery program was redesigned, and interventions were implemented related to preoperative care, intraoperative monitoring, postoperative care, and the cardiac surgery quality management program.
  
  
  RESULTS
  According to the most recent New York State Department of Health reporting period (2009-2011), Long Island Jewish Medical Center had the lowest risk-adjusted mortality rate in New York State for adult patients undergoing surgeries to repair or replace heart valves and for adult patients in need of valve/coronary artery bypass graft surgery. The medical center has sustained significantly lower mortality rates compared to the statewide average for the past three cardiac surgery reporting periods.
  
  
  CONCLUSIONS
  Cardiac surgery mortality rates can be significantly reduced and sustained below comparative norms when the organization is committed to clinical excellence and quality and is involved in continuously assessing organizational performance. The evaluation launched at Long Island Jewish Medical Center led to the redesign of the cardiac surgery program and prompted widespread improvement efforts and cultural change across the entire organization.
authors.affiliation: Cardiothoracic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: S Jacob
authors.initials: SJ
authors.lastname: Scheinerman
authors.forename: Yosef D
authors.initials: YD
authors.lastname: Dlugacz
authors.forename: Alan R
authors.initials: AR
authors.lastname: Hartman
authors.forename: Donna
authors.initials: D
authors.lastname: Moravick
authors.forename: Karen L
authors.initials: KL
authors.lastname: Nelson
authors.forename: Kerri Anne
authors.initials: KA
authors.lastname: Scanlon
authors.forename: Lori
authors.initials: L
authors.lastname: Stier
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000401:mortality*; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D009518:New York; D010043:Outcome and Process Assessment, Health Care; D019990:Perioperative Care / Q000379:methods; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care; D018570:Risk Assessment