Implementation of a process-orientated multidisciplinary approach (POMA), a system of cost-effective healthcare delivery within a cardiac surgical unit

Published on Dec 1, 2008in Quality & Safety in Health Care
· DOI :10.1136/QSHC.2006.021279
David J. O'Regan27
Estimated H-index: 27
(LGI: Leeds General Infirmary),
Samir S. Shah4
Estimated H-index: 4
+ 3 AuthorsM Jarvis1
Estimated H-index: 1
Sources
Abstract
Background: The process-orientated multidisciplinary approach (POMA) is a means of delivering consultant-led healthcare from the first outpatient clinic visit through to discharge, bringing together clinical and operational management that can result in effective resource utilisation and improved patient care. Methods: Prospectively collected data from patients undergoing primary isolated coronary artery bypass graft (CABG) were collected before and after the application of POMA (246 and 260 patients, respectively). The impact of POMA was analysed on the number of cancellations (NOC), postoperative clinical incidents (POCI), postoperative length of stay (PLOS) and cost in the practice of one consultant surgeon. Data were obtained from our clinical database (PATS—Dendrite), which is used risk stratify patients and prospectively to collect clinical/operative data and outcomes. Results: Patients were matched for all variables except for the European Cardiac Surgical Risk Score (EuroSCORE) which was 1.93 for pre-POMA patients and 2.73 for post-POMA patients (p<0.05). Cancellations significantly decreased from 4.5% (n = 11, pre-POMA) to 0.4% (n = 1, post-POMA) (p<0.05). POCI significantly decreased from 44.3% (n = 109, pre-POMA) to 36.2% (n = 94, post-POMA) (p<0.05). PLOS significantly decreased from 6.3 (pre-POMA) to 6.1 days (post-POMA) (p = 0.002). Regression analysis showed that implementation of POMA was the only significant factor in the reduction of POCI and PLOS (p<0.05). POMA resulted in an overall saving of £285 868 (€400,215; US$508,845) calculated using the 2005 National Health Service (NHS) tariffs. Conclusions: The implementation of POMA was the only significant known (or measured) factor that improved the operational efficiency and clinical outcome of a single surgeon’s practice. The authors believe the principles deserve to be studied further to see if the results can be replicated.
📖 Papers frequently viewed together
16 Citations
5 Authors (M. Davies, ..., John R. Peters)
98 Citations
116 Citations
References14
Newest
#1David C. WilsonH-Index: 22
The topic of change has been centre stage in organization theory for many years. It continues to be a central theme, exercising the minds of scholars in many disciplines as well as practitioners to try and explain both the how and the why of organizational change. To try and seek an original theory of change as a starting point for the multiple perspectives we currently embrace is something of a false trail, Each theory of change we now draw upon (see following section) is inextricably embedded ...
46 Citations
37 CitationsSource
#1Mark Jenkins (Cranfield University)H-Index: 18
#2Ken PasternakH-Index: 2
Last. Richard WestH-Index: 3
view all 3 authors...
The world of Formula 1® is a powerful mirror to the world of management, where high performance relies on strong leadership, clear goals, selfless teamwork, innovation through constant learning and a winning culture. Performance at the Limit: Business Lessons from Formula 1® Motor Racing uses the case of Formula 1® to demonstrate how business can achieve optimal performance in highly competitive and dynamic environments. This third edition has been extensively updated, including a powerful new f...
32 Citations
#1Sherif R. Gobran (Christiana Care Health System)H-Index: 1
#2Scott M. Goldman (Main Line Health)H-Index: 21
Last. Francis P. Sutter (Main Line Health)H-Index: 14
view all 8 authors...
Background Off-pump coronary artery bypass (OPCAB) may be associated with improved outcomes when compared with on-pump coronary artery bypass. This study evaluates the use of a system for access and stabilization (SAS) with a coronary stabilizer as well as a clinical effectiveness quality initiative (CEQI) process regarding outcomes. This included the development of an expanded heart care team as well as standardization and refinement of perioperative care at The Lankenau Hospital (TLH). Our aim...
20 CitationsSource
#1Pieter Degeling (Durham University)H-Index: 17
#2S MaxwellH-Index: 4
Last. David J. HunterH-Index: 235
view all 4 authors...
The current focus on quality and safety means most doctors have negative views about clinical governance. But done properly, clinical governance has the power to improve NHS performance
92 CitationsSource
BACKGROUND: Dissatisfaction with clinical outcomes prompted an intervention to assess and improve processes and outcomes in a cardiac surgery unit. METHODS: Starting on September 1st, 1998, 1836 consecutive patients requiring a heart operation in our unit were prospectively enrolled by recording a series of anamnestic, clinical and procedural descriptors in a dedicated database. Expected mortality rates were estimated by means of nine different stratification models, one of which also allowed th...
1 Citations
#1Sven Beholz (Humboldt University of Berlin)H-Index: 4
#2C. KochH-Index: 1
Last. W. KonertzH-Index: 1
view all 3 authors...
Background: A quality management system (QMS) will improve quality in health care units. This report describes the introduction of a QMS according to ISO 9001:2000 in a university cardiovascular surgery department. Methods: First, a thorough analysis of all processes of patient treatment and clinical research was obtained. Multiple interfaces were defined to different departments as well as to administration units. We evaluated and optimized all necessary resources, evaluating customer satisfact...
24 CitationsSource
Managing may be managing, but it is practiced in a wide range of ways in the so-called 'healthcare' system. All or in some cases part of a day in the life of seven managers is described and then analysed, separately and then together. This presents a consistent picture of the varieties as well as the discontinuities in managing this hopefully integrated system.
39 CitationsSource
#1William L. Holman (UA: University of Alabama)H-Index: 52
#2Richard M. AllmanH-Index: 67
Last. Robert G. SherrillH-Index: 3
view all 9 authors...
ContextEfforts to improve quality of care in the cardiac surgery field have focused on reducing the risk-adjusted mortality associated with common surgical procedures, such as coronary artery bypass grafting (CABG). However, the best methodological approach to improvement is under debate.ObjectiveTo test an intervention to improve performance of CABG surgery.Design and SettingQuality improvement project based on baseline (July 1, 1995–June 30, 1996) and follow-up (July 1–December 31, 1998) perfo...
56 CitationsSource
: Today's rapidly changing health care environment has thrust upon the caregivers, patients, and their families many challenges. A multidisciplinary team continuously analyzes strengths, weaknesses, and threats to the success of heart centers. Prolonged hospitalization for cardiac surgery patients is consistently identified as a priority with multiple opportunities for improvement. All patients are monitored for variables known to impact length of stay including same day admission, intubation ti...
1 Citations
Cited By12
Newest
#1S. Llanos (Hospital Clínico San Carlos)
#2María Galán-Olleros (Hospital Clínico San Carlos)H-Index: 2
Last. Fernando Marco (Hospital Clínico San Carlos)H-Index: 21
view all 6 authors...
Abstract Introduction The high prevalence of forefoot pathology generates long surgical waiting lists (SWL). We have detected a considerable number of patients who withdraw surgery, which creates an important distortion in our activity and high expenditure of resources. Our objective is to study the factors related to these resignations, as well as, compare them with other pathologies of high prevalence and ambulatory surgical treatment: carpal tunnel syndrome (CTS) and internal meniscopathy (IM...
Source
#1Einar Hovlid (Sogn og Fjordane University College)H-Index: 6
#2Oddbjørn Bukve (Sogn og Fjordane University College)H-Index: 6
Background Contextual factors influence quality improvement outcomes. Understanding this influence is important when adapting and implementing interventions and translating improvements into new settings. To date, there is limited knowledge about how contextual factors influence quality improvement processes. In this study, we explore how contextual factors affected measures to reduce surgery cancellations, which are a persistent problem in healthcare. We discuss the usefulness of the theoretica...
16 CitationsSource
#1Zena MooreH-Index: 26
#2Gillian ButcherH-Index: 1
Last. Kristien Van AckerH-Index: 14
view all 6 authors...
Background - The growing prevalence and incidence of nonhealing acute and chronic wounds is a worrying concern. A major challenge is the lack of united services aimed at addressing the complex needs of individuals with wounds. However, the WHO argues that interprofessional collaboration in education and practice is key to providing the best patient care, enhancing clinical and health-related outcomes and strengthening the health system. It is based on this background that the team approach to wo...
33 CitationsSource
#1Joyce A. Wahr (UMN: University of Minnesota)H-Index: 25
#2James H. Abernathy (MUSC: Medical University of South Carolina)H-Index: 15
The past 5 decades have seen an incredible advance in cardiac surgery knowledge, techniques, equipment, skill sets, and outcomes. Even as our average cardiac surgery patient becomes older with more significant cardiac disease and medical comorbidities, mortality continues to decrease. However, many of the deaths that do occur have been shown to be preventable. These preventable deaths are more often due to non-technical errors, such as communication failures, distractions, and disruptions, than ...
4 CitationsSource
#1Joyce A. Wahr (AHA: American Heart Association)H-Index: 25
#2Richard L. Prager (AHA: American Heart Association)H-Index: 36
Last. Nancy A. Nussmeier (AHA: American Heart Association)H-Index: 31
view all 21 authors...
The cardiac surgical operating room (OR) is a complex environment in which highly trained subspecialists interact with each other using sophisticated equipment to care for patients with severe cardiac disease and significant comorbidities. Thousands of patient lives have been saved or significantly improved with the advent of modern cardiac surgery. Indeed, both mortality and morbidity for coronary artery bypass surgery have decreased during the past decade (Figure 1).1 Nonetheless, the highly s...
171 CitationsSource
#1Einar Hovlid (University of Bergen)H-Index: 6
#2Christian von Plessen (University of Stavanger)H-Index: 13
Last. Oddbjørn Bukve (Sogn og Fjordane University College)H-Index: 6
view all 5 authors...
Background The cancellation of planned surgery harms patients, increases waiting times and wastes scarce health resources. Previous studies have evaluated interventions to reduce cancellations from medical and management perspectives; these have focused on cost, length of stay, improved efficiency, and reduced post-operative complications. In our case a hospital had experienced high cancellation rates and therefore redesigned their pathway for elective surgery to reduce cancelations. We studied ...
25 CitationsSource
#1Frank W. SellkeH-Index: 82
#2Nancy A. NussmeierH-Index: 31
Last. Eduardo SalasH-Index: 2
view all 19 authors...
#1Einar Hovlid (University of Bergen)H-Index: 6
#2Oddbjørn Bukve (Sogn og Fjordane University College)H-Index: 6
Last. Christian von Plessen (University of Bergen)H-Index: 13
view all 5 authors...
Changes that improve the quality of health care should be sustained. Falling back to old, unsatisfactory ways of working is a waste of resources and can in the worst case increase resistance to later initiatives to improve care. Quality improvement relies on changing the clinical system yet factors that influence the sustainability of quality improvements are poorly understood. Theoretical frameworks can guide further research on the sustainability of quality improvements. Theories of organizati...
53 CitationsSource
#1Einar Hovlid (University of Bergen)H-Index: 6
#2Oddbjørn Bukve (Sogn og Fjordane University College)H-Index: 6
Last. Christian von Plessen (University of Bergen)H-Index: 13
view all 5 authors...
Background The cancellation of planned surgeries causes prolonged wait times, harm to patients, and is a waste of scarce resources. To reduce high cancellation rates in a Norwegian general hospital, the pathway for elective surgery was redesigned. The changes included earlier clinical assessment of patients, better planning and documentation systems, and increased involvement of patients in the scheduling of surgeries. This study evaluated the outcomes of this new pathway for elective surgery an...
47 CitationsSource
#1Esther Suter (AHS: Alberta Health Services)H-Index: 32
#2Siegrid Deutschlander (AHS: Alberta Health Services)H-Index: 7
Last. Ruby Grymonpre (UM: University of Manitoba)H-Index: 14
view all 12 authors...
Many studies examine the impact of interprofessional (IP) interventions on various health practice and education outcomes. One significant gap is the lack of research on the effects of IP interventions on health human resource (HHR) outcomes. This project synthesized the literature on the impact of IP interventions at the pre- and post-licensure levels on quality workplace, staff satisfaction, recruitment, retention, turnover, choice of employment and cost effectiveness. Forty-one peer-reviewed ...
63 CitationsSource