Qual Saf Health Care 16:192-196 doi:10.1136/qshc.2004.012435
  • Original Article

Monitoring the rate of re-exploration for excessive bleeding after cardiac surgery in adults

  1. Rory Wolfe1,
  2. Stephen Bolsin2,
  3. Mark Colson2,
  4. Peter Stow3
  1. 1Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  2. 2Division of Anaesthesia, Perioperative Medicine & Pain Management, The Geelong Hospital, Geelong, Victoria, Australia
  3. 3Intensive Care Unit, The Geelong Hospital, Geelong, Victoria, Australia
  1. Correspondence to:
 Associate Professor S Bolsin
 Division of Perioperative Medicine, Anaesthesia & Pain Management, The Geelong Hospital, Geelong, Victoria 3220, Australia; steveb{at}
  • Accepted 1 March 2007


Background: 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.

Objective: 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.

Methods: Shewhart charts, moving average plots and cumulative sum (CUSUM) charts were used to demonstrate changes in the rate of re-exploration over time.

Results: 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.

Conclusion: Statistical monitoring techniques for quality assurance can identify important changes in clinical performance, and their adoption by clinicians is recommended.


  • Competing interests: None declared.

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