National databases and clinical practice specialist: decreasing postoperative atrial fibrillation following cardiac surgery

In this article, we document how an interdisciplinary committee of health professionals led to an approximate 50% reduction in the incidence of postoperative atrial fibrillation (AF) following a cardiac surgery procedure by using preoperative loading and dosing of PO amiodarone and beta blockade. Patients in this report (n = 3397) included all coronary artery bypass surgery (CABG) and valve replacement/repair procedures from January 1, 2000 to June 30, 2002. The incidence of postoperative AF for a CABG or valve replacement/repair procedure was 19.0% for period A (preprotocol) and 13.5% for period B (postprotocol). This translates into an absolute risk reduction of 5.5% or 113 actual cases of postoperative AF reduced. The role of the clinical practice specialist, a master's prepared nurse, and participation in the national Society of Thoracic Surgeon's database allowed us to track our CABG outcomes, benchmark our outcomes against both national and regional institutions, and make changes in outcomes incidence through performance improvement.