Although cardiac procedures are commonly used to treat cardiovascular disease, they are costly. Administrative data sources could be used to track cardiac procedures, but sources of such data have not been validated against clinical registries.
To examine accuracy of cardiac procedure coding in administrative databases versus a prospective clinical registry.
We examined a total of 182,018 common cardiac procedures including percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery, valve surgery, and cardiac catheterization procedures during fiscal years 2005 and 2006 across 18 cardiac centers in Ontario, Canada.
Accuracy of codes in the Canadian Institute for Health Information (CIHI) administrative databases were compared with the clinical registry of the Cardiac Care Network.
Comparing 17,511 CIHI and 17,404 registry procedures for CABG surgery, the positive predictive value (PPV) of CIHI-coded CABG surgery was 97%. In 6229 CIHI-coded and 5885 registry-coded valve surgery procedures, the PPV of the administrative data source was 96%. Comparing 38,527 PCI procedures in CIHI to 38,601 in the registry, the PPV of CIHI was 94%. Among 119,751 CIHI-coded and 111,725 registry-coded cardiac catheterization procedures, the PPV of administrative data was 94%. When the procedure date window was expanded from the same day to ±1 days, the PPV was 96% (PCI) and exceeded 98% (CABG surgery), 97% (valve surgery), and 95% (cardiac catheterization).
Using a clinical registry as the gold standard, the coding accuracy of common cardiac procedures in the CIHI administrative database was high.
One of the ways to cut down the time interval from the moment a patient with acute myocardial infarction calls for aid until the time of his hospitalization is to increase the number of cardiological teams and also to define in detail the sequence of the appropriate actions of the controller and the emergency aid physician. As a result of the earlier arrival of specialized cardiologic teams at the place of the call, there has been a change in the structure of complications that such teams encounter; for example, cases of clinical death have occurred more frequently in the presence of the team. Subsequently, the number of cases of effective resuscitation rose from 5 in 1979 to 13 in 1982. The gradual reduction over four years of the duration of the prehospital stage in acute myocardial infarction has led to a decrease in both prehospital and hospital mortality. Interestingly, the prehospital mortality rate lowered gradually whereas the hospital mortality reduced significantly during the first year after which its parameters stabilized.
To evaluate the influence of nurse staffing and work environment variables on patient outcomes by testing a conceptual model.
A prospective, correlational design with cross-sectional and longitudinal components was conducted in Canadian cardiac and cardiovascular care inpatient units.
Data were collected from multiple sources. Hierarchical linear modeling was used to examine relationships among variables.
The findings indicate that patient outcomes are influenced not only by patient and nurse characteristics, but also by organizational staffing practices. Organizations that manage the complexity of work conditions and target staffing utilization levels between 80% and 88% at the unit level can optimize patient outcomes.
Empirical validation of the model provides evidence to inform management decisions about hospital nurse staffing.