Clinically important respiratory pathology is detectable by lung ultrasound in a substantial number of noncritically ill, pre or postoperative cardiothoracic surgery participants with high estimate of interobserver agreement beyond that expected by chance, and we showed clinically significant diagnoses may be missed by the contemporary practice of clinical examination and CXR.
It is a statewide clinical quality registry with almost all hospitals performing PCI in Victoria contributing. VCOR provides insights into overall trends in a hospital's quality performance, with quarterly, annual and ad-hoc reporting. We undertook a detailed analysis (deep dive) of hospital performance related to PCI for acute STEMI to gain insights into factors that influence the quality of care. Methods: 13 public and 10 private hospitals contribute baseline, procedural, in-hospital and 30-day outcomes via a secure web-based system. All sites receive quarterly reports providing individualised comparative outcomes. Results: 1133 consecutive STEMI patients were treated over a 12-month period from July 2014; 39% in private hospitals. The mean age was 62 ± 12.6yrs. Females comprised 19%. Pre-hospital notification (PHN) of STEMI by faxed ECG occurred in 48%. Median door-to-balloon (DTB) time for the overall cohort was 69 min (IQR 46-100). Median compliance with DBT < 90 min was 69% (range 46%-87%). PHN improved compliance for DBT < 90 min by 34% compared with no PHN. Many health services exhibited a fall-off in performance for out-of-hours cases, with a reduction in compliance rate to 64% (range 36%-80%). Compliance with DBT < 90 min did not influence mortality or length of stay. Conclusion: Detailed analysis of performance measures for PCI for STEMI reveals variation across Victorian hospitals and compliance with door-to-balloon times < 90 min below target. Improving out-of-hrs delays and use of pre-hospital notification have measurable beneficial effects on performance.
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