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This version was published on April 1, 2008
American Journal of Medical Quality, Vol. 23, No. 2, 90-95 (2008)
DOI: 10.1177/1062860607313141
© 2008 American College of Medical Quality

When Things Go Wrong: The Impact of Being a Statistical Outlier in Publicly Reported Coronary Artery Bypass Graft Surgery Mortality Data

Walter H. Ettinger, MD, MBA

UMass Memorial Medical Center, Worcester, Massachusetts, ettingew{at}ummhc.org

Sharon M. Hylka, RN, MSN, CNA

UMass Memorial Medical Center, Worcester, Massachusetts

Robert A. Phillips, PhD, MD

UMass Memorial Medical Center, Worcester, Massachusetts

Lynn H. Harrison, Jr, MD

UMass Memorial Medical Center, Worcester, Massachusetts

Jay A. Cyr, MS, RN, MBA

UMass Memorial Medical Center, Worcester, Massachusetts, University of Massachusetts School of Medicine, Worcester, Massachusetts

Andrew J. Sussman, MD, MBA

UMass Memorial Medical Center, Worcester, Massachusetts, University of Massachusetts School of Medicine, Worcester, Massachusetts

The public reporting of hospital quality and safety data is a growing phenomenon. Yet there are few reports of the effects of publicly reported data on individual organizations, particularly when the data show worse than expected performance. In this article, our hospital's response to having a mortality rate from coronary artery bypass graft surgery that was significantly higher than other programs in the Commonwealth of Massachusetts is reported. The data caused suspension of elective cardiac surgery at the institution, and an independent review of the program was undertaken. The effects of the suspension and publication of mortality data on quality and patient safety, the residency training program in cardiothoracic surgery, and the financial performance of the hospital are described. Several lessons were learned that may be of value to other health care organizations that experience a public crisis in clinical quality. (Am J Med Qual 2008;23:90-95)

Key Words: cardiac surgery • performance improvement • public reporting • mortality rates


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