CONTINUOUS QUALITY IMPROVEMENT DECREASES LENGTH OF STAY AND ADVERSE EVENTS - A CASE-STUDY IN AN INTERVENTIONAL CARDIOLOGY PROGRAM

A study was performed to assess the effectiveness of continuous qualit y improvement in achieving a better quality of care for patients under going coronary interventions. Increasing utilization of new coronary i nterventional devices has incurred a higher incidence of complications , prolonged hospital stay, and related costs. Using a clinical informa tion system, we adopted continuous quality improvement to control the incidence of complications and postprocedural length of stay. Multiple regression analysis and a matched case-control study were performed t o detect complications related to postprocedural length of stay and th eir causes among 342 patients. The results led to the modification of the postprocedural heparin anticoagulation protocol, which was followe d by the introduction of a ticlopidine-based poststent anticoagulation regimen. Two sequential groups of patients (n 261,n = 266) were selec ted to compare postprocedural length of stay and frequency of complica tions with those for the first group. Adjustments were made for patien ts and procedural characteristics through stratification and multiple regression methods. Blood transfusion was the most important predictor of prolonged hospital stay (partial R-2 = 0.26, P < 0.01). A high lev el of postprocedural anticoagulation and intracoronary stent use were significantly associated with blood transfusion (P 0.01, P 0.02, respe ctively). The comparison among the three groups showed that heparin pr otocol change reduced only postprocedural length of stay (P < 0.001) f or patients without stents, whereas the stent change in anticoagulatio n protocol significantly reduced both transfusion and hospital stay fo r patients with stents (P < 0.001, P < 0.05, respectively). Continuous quality improvement based on clinical information is promising to con trol both complications and hospital costs. Physician involvement is n ecessary throughout the process.