Routine registration of deviations from the norm in cardiac surgery: a potent clinical research tool and quality assurance measure1

Abstract

The surveillance and monitoring of deviations from normality is an oftenused quality assurance weapon in private industry. In cardiac surgery,complications have often been monitored and reported, but mostly one at atime and in conjunction with a scientific study. METHODS: Using theclinic's data network including operating theatre, intensive care unit andward, deviations from a normal postoperative course are registered by thepatient's nurses. The deviations are registered by answering questions onall organ systems in front of a PC. Suitable definitions are available tothe nurse. When the patient is discharged, the surgeon in charge willreview the deviations noted and make a formal diagnosis on the patient'schart if appropriate. RESULTS: The data system has now been in use for 6months. It was easily adopted by the nurses. The doctor's work isfacilitated as relevant data are available to him when discharging thepatient and making the discharge note. 58% of the patients have some kindof deviation from the norm, most commonly in the cardiovascular system (30%of the patients), respiratory system (22%), and surgically complicatedpostoperative course (17%). During the first months of registration itbecame apparent that too many patients had postoperative thrombophlebitis.By changing routines, the incidence of thrombophlebitis decreased from 5 to< 1%. CONCLUSION: Only about 40% of our patients go through a cardiacoperation with a totally normal postoperative course. The registrationsystem has turned out to be easily handled by our nurses and able to detectcomplications not immediately noticed in everyday clinical practice. Aregistry of this kind is highly dependent on its definitions and on thegeneral 'norm' prevailing. Findings from such registries cannot thereforebe immediately compared with those of other institutions. The researchpotentials of the registry as well as its role in quality assurance seemlarge.