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Transforming administrative data into real-time information in the Department of Surgery
  1. Peter A Beaulieu1,2,
  2. John H Higgins1,2,
  3. Lawrence J Dacey1,2,
  4. William C Nugent1,2,
  5. Gordon R DeFoe1,2,
  6. Donald S Likosky1,2
  1. 1Department of Surgery, Dartmouth Medical School, Hanover, New Hampshire, USA
  2. 2The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth Medical School, Lebanon, New Hampshire, USA
  1. Correspondence to Dr Donald Likosky, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA; donald.s.likosky{at}


Background Cardiothoracic surgical programmes face increasingly more complex procedures performed on evermore challenging patients. Public and private stakeholders are demanding these programmes report process-level and clinical outcomes as a mechanism for enabling quality assurance and informed clinical decision-making. Increasingly these measures are being tied to reimbursement and institutional accreditation. The authors developed a system for linking administrative and clinical registries, in real-time, to track performance in satisfying the needs of the patients and stakeholders, as well as helping to drive continuous quality improvement.

Methods A relational surgical database was developed to link prospectively collected clinical data to administrative data sources at Dartmouth-Hitchcock Medical Center. Institutional performance was displayed over time using process control charts, and compared with both internal and regional benchmarks.

Results Quarterly reports have been generated and automated for five surgical cohorts. Data are displayed externally on our dedicated website, and internally in the cardiothoracic surgical office suites, operating room theatre and nursing units. Monthly discussions are held with the clinical staff and have resulted in the development of quality-improvement projects.

Conclusions The delivery of clinical care in isolation of data and information is no longer prudent or acceptable. The present study suggests that an automated and real-time computer system may provide rich sources of data that may be used to drive improvements in the quality of care. Current and future work will be focused on identifying opportunities to integrate these data into the fabric of the delivery of care to drive process improvement.

  • Cardiopulmonary bypass grafting
  • outcomes
  • quality improvement
  • continuous quality improvement
  • healthcare quality improvement
  • microsystem
  • statistical process control
  • surgery

Statistics from


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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