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Quality Improvement Yields Better-Than-Expected Mortality Rates at UCSF

At the UCSF Heart and Vascular Center, the adult inpatient mortality rates are better than expected across all services. These positive outcomes are driven by the team’s structured approach to quality improvement, according to Krishan Soni, MD, FACP, FACC, MBA, interventional cardiologist and the center’s medical director of quality and safety.

“These numbers represent a very high level of quality-of-care,” he said. “Our heart and vascular quality council meets regularly to review real-time mortality data. We share it with all the teams, look for every opportunity to do as well as or better than the median, and take deep dives into quality improvement projects.”

Implementing a quality improvement strategy

The Heart and Vascular Center’s ongoing quality improvement strategy includes:

  • Multidisciplinary conferences to coordinate care for patients with high-risk coronary disease, valve disease or emergency coronary events
  • Dedicated intensive care teams within the Heart and Vascular Center to treat critically ill patients
  • Expanded teams that include advanced practice providers to ensure continuity of high-quality care for patients in all settings 
  • Pathways and protocols for standardized care for stable-to-critical patients
  • Routine audit feedback and review of mortality data within the Heart and Vascular Center
  • Partnership with the documentation integrity team to ensure capture of illness severity and morbidities in clinical documentation

Improving surgical outcomes

The UCSF Cardiac Surgery Program, led by Tom C. Nguyen, MD, FACS, FACC, has achieved significant improvements in mortality rates and other surgical outcomes as measured by the Society of Thoracic Surgeons (STS) National Database.

“We always put patients first and rely on a truly collaborative, multidisciplinary approach to patient care,” Nguyen said. “We lean on published data and our experience to make decisions, and then we standardize decision-making processes and develop pathways for patient management.”

Nguyen joined UCSF as division chief for adult cardiothoracic surgery in January 2021 and has built an experienced surgical team. “We’ve recruited national and international experts in the field of adult cardiac surgery, including experts in minimally invasive bypass surgery, heart failure, transplant and minimally invasive valve surgery,” he said. “As a team, we make sure that everyone knows their role and what the goal is.”

Lifesaving treatment for STEMI patient

The Heart and Vascular Center’s continuous improvement strategy for ST-elevation myocardial infarction (STEMI) care led to a Mission: Lifeline Silver Plus Receiving Achievement Award from the American Heart Association. “We care for some of the very sickest patients,” Soni said. “We focus on fast door-to-balloon times.”

Soni recalled a STEMI patient who experienced multiple cardiac arrests and cardiogenic shock while hospitalized. The multidisciplinary team performed an angioplasty, placed a stent, and stabilized the patient using ECMO and an Impella pump. “He was critically ill and could have been a mortality,” Soni said. “But he’s a success story.” 

Culture of data availability and transparency

“At UCSF, there’s a very high level of collaboration and teamwork,” Soni said. “We have multidisciplinary conferences to discuss patient care. Our teams of advanced practice providers deliver very high level and consistent care. 

“There’s also a culture of data availability and transparency,” he continued. “We use this data to drive patient care plans. These practices improve patient outcomes.”

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