[Impact of the management of a cardiac unit on cardiac care delivery. Evolution of clinical effectiveness indicators].

INTRODUCTION AND OBJECTIVES Cardiac care is one of the most important and rapidly rising costs in the healthcare system. Therefore, any improvement can produce significant savings. We analyze the evolution of classical clinical effectiveness indexes in a cardiac unit after a change in clinical management. METHODS We reviewed overall clinical effectiveness indexes and the most significant DRGs of a cardiac unit and general hospital between 1992 and 2000. A change in management (optimization of time for studies, responsibility of professionals for tasks, close follow-up, and preventive problem management) was introduced in September 1995 by team members without a parallel change in the hospital. Clinical effectiveness indexes were compared before and after the organizational change and compared with the rest of the hospital. RESULTS There was a progressive improvement in clinical effectiveness indexes in the hospital (reduction of 22% in length of stay). On the other hand, a significant improvement was also noted in the cardiac unit starting the month after implementing the new management strategy (reduction of 54% in the duration of the hospital stay; 9.74 days preintervention vs 4.97 days postintervention; p < 0.001). Improvement has been progressive throughout the years of follow-up. Overall indexes and specific DRG indicators improved. CONCLUSIONS A change in management strategy can have a significant impact on cardiac care and improve clinical effectiveness. Therefore, the attitude of a small team can have a significant impact on healthcare.