Quality Care That Makes a Difference

The Stanford Hospital Heart Transplant Program has established a comprehensive Quality and Clinical Effectiveness Program to improve patient outcomes and satisfaction after undergoing heart transplantation. We monitor hospital length of stay, re-hospitalization rates, acute rejection rates, patient satisfaction scores, and national quality data from the University HealthSystem Consortium to help us identify areas for improvement and to monitor the effectiveness of our quality improvement initiatives.

Understanding the data

Many patients referred to Stanford Health Care for heart transplantation are very sick and may have other medical conditions or heart failure complications that decrease their chances for survival after a heart transplant. The mortality Observed to Expected (O/E) ratio compares patients' actual mortality rates to their expected mortality rates--which take into account the severity of a patient's illness. An O/E ratio of 1.0 indicates that the observed mortality rate equaled the expected mortality rate based on patients' level of illness, while a lower O/E mortality ratio means that more patients survived than were expected due to the severity of their illness. The O/E mortality ratio among patients undergoing heart transplantation at Stanford has been declining steadily since 2009.

Extending our commitment to quality

The Heart Transplant Quality Council is a multidisciplinary committee consisting of cardiologists, cardiothoracic surgeons, advanced practice nurses, nurse coordinators, patient care unit managers, social workers and other members of the heart transplant team who meet monthly to monitor and address quality data and patient adverse events, and to oversee the program's quality initiatives. Some of the quality initiatives being implemented by the Quality Council to improve survival and patient satisfaction after a heart transplant include:

• Updating immunosuppressive medications to incorporate the use of newer drugs with more specific action on immune cells and to decrease the use of corticosteroids, which can cause rapid weight gain, increase susceptibility to infection and worsen control of blood glucose levels in diabetic patients.
• Providing patients with consultative care by specialized heart transplant cardiologists immediately after transplant surgery.
• Developing a clinical pathway to establish clear goals of care for patients recovering from their heart transplant surgeries. These efforts will improve coordination of care among physicians, nurses, and other team members involved in the patient's hospital stay.
• Establishing a dedicated cell phone number for patients to reach the on-call heart transplant physician, 24 hours a day, 7 days a week, in case of medical emergencies.