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

UNLABELLED

The surveillance and monitoring of deviations from normality is an often used quality assurance weapon in private industry. In cardiac surgery, complications have often been monitored and reported, but mostly one at a time and in conjunction with a scientific study.

METHODS

Using the clinic's data network including operating theatre, intensive care unit and ward, deviations from a normal postoperative course are registered by the patient's nurses. The deviations are registered by answering questions on all organ systems in front of a PC. Suitable definitions are available to the nurse. When the patient is discharged, the surgeon in charge will review the deviations noted and make a formal diagnosis on the patient's chart if appropriate.

RESULTS

The data system has now been in use for 6 months. It was easily adopted by the nurses. The doctor's work is facilitated as relevant data are available to him when discharging the patient and making the discharge note. 58% of the patients have some kind of deviation from the norm, most commonly in the cardiovascular system (30% of the patients), respiratory system (22%), and surgically complicated postoperative course (17%). During the first months of registration it became 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 cardiac operation with a totally normal postoperative course. The registration system has turned out to be easily handled by our nurses and able to detect complications not immediately noticed in everyday clinical practice. A registry of this kind is highly dependent on its definitions and on the general 'norm' prevailing. Findings from such registries cannot therefore be immediately compared with those of other institutions. The research potentials of the registry as well as its role in quality assurance seem large.