Using database information in your clinical practice

Background. Clinical database information is in nide demand, but it is not always used to its full potential. Clinicians must learn to be the experts and to assert leadership in the use of their own data. Methods. Clinical databases provide unique perspectives on the full process of care for a heterogeneous population of patients. They focus beyond indi vidual providers, to their interaction within a complex system of care. Exp loring questions that arise from this data can identify system issues, whic h are invisible to individual practitioners or specialties using other trad itional review methods. Results. Clinical database information helped our hospital staff: identify problems in their approach to a small subset of high risk coronary bypass p atients. Multiple system changes resulted in a dramatic reduction in mortal ity. Collateral impact on all care reduced overall mortality from 4.5% to b elow 2%. Conclusions. The greatest opportunities for improvement in patient care oft en lie in the areas where specialties or teams interface, eg, in overlappin g or transferring care. The whole system of care for each patient must be o ptimized, not just the individual specialty components. Clinical database i nformation provides a way to evaluate and improve the overall process and r esults of the broader system of patient care. (C) 1999 by The Society of Th oracic Surgeons.