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It is my strong contention that patients facing cardiac surgery should choose an institution, not a particular heart surgeon. Although individual judgement and technical dexterity are obviously important, best surgical outcomes reflect the performance of many medical providers before, during and after the operation. Professionalism and a competitive business environment both stimulate open heart centers to continuously focus on quality assurance programs to improve patient safety. Also, continuing medical education of surgical staff, advances in technology and classic peer review of adverse outcomes have impacted death and complication rates. However, preventing avoidable harm is still a significant challenge despite innumerable checklists, preoperative briefings, postoperative debriefings and team training programs.

That is why a recent report published in the Journal of the American Medical Association from the Veterans Health System is so remarkable. Seventy-four facilities underwent a team-training program comprised of 2 months of instruction, a 1 day conference and 1 year of quarterly coaching interviews and audits. The program was aimed at forming a cohesive approach towards improving patient safety by surgeons, anesthesiologists, nurses and associated operating room heathcare staff. Over a two year period, the 30 day mortality rate for major surgical procedures at participating hospitals was reduced 18% which absolute rate was only 1/2 the concurrent mortality at hospitals that has not undergone the training. Supporting the value of institutional commitment to this approach was the “dose-response” relationship between successive calendar quarterly training and mortality rate. The death rate progressively decreased with each sequential 3 month period of participation. The 182,409 procedures were not cardiac, but the principles certainly apply to open-heart surgery. The efficacy of this new approach is more impressive given the fact that the hospitals not yet enlisted had in place what were felt to be effective, up-to-date quality programs.

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