Wolfe Rory, Bolsin Stephen, Colson Mark, Stow Peter
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Qual Saf Health Care. 2007 Jun;16(3):192-6. doi: 10.1136/qshc.2004.012435.
The monitoring of adverse events in clinical care can be an important part of quality assurance. There is little evidence on the monitoring of re-exploration after cardiac surgery.
To apply statistical monitoring techniques to the rate of re-exploration for excessive bleeding in adult patients undergoing cardiac surgery procedures using cardiopulmonary bypass at Geelong Hospital, Victoria, Australia, between 1997 and 2003.
Shewhart charts, moving average plots and cumulative sum (CUSUM) charts were used to demonstrate changes in the rate of re-exploration over time.
A CUSUM chart was used retrospectively at a time of perceived deteriorating clinical outcomes in patients of the cardiac surgery service. At this time, an intervention aimed at reducing the re-exploration rate was performed, and subsequent CUSUM charts indicated an improvement in this rate. The CUSUM chart has become an important part of the quality feedback of clinical care outcomes within the Anaesthesia & Pain Management unit of Geelong Hospital.
Statistical monitoring techniques for quality assurance can identify important changes in clinical performance, and their adoption by clinicians is recommended.
临床护理中不良事件的监测可能是质量保证的重要组成部分。关于心脏手术后再次手术探查的监测证据很少。
运用统计监测技术，对1997年至2003年期间在澳大利亚维多利亚州吉朗医院接受体外循环心脏手术的成年患者因出血过多而进行再次手术探查的发生率进行分析。
使用休哈特控制图、移动平均线图和累积和（CUSUM）控制图来展示再次手术探查发生率随时间的变化。
在心脏外科服务的患者临床结局被认为恶化时，回顾性地使用了CUSUM控制图。此时，实施了旨在降低再次手术探查率的干预措施，随后的CUSUM控制图显示该发生率有所改善。CUSUM控制图已成为吉朗医院麻醉与疼痛管理部门临床护理结局质量反馈的重要组成部分。
用于质量保证的统计监测技术可以识别临床绩效的重要变化，建议临床医生采用这些技术。
