Maintaining Quality in Lower Volume Cardiac Surgery: A Blueprint From a Military Program

Jared L. Antevil*, Philip S. Mullenix, Junewai L. Reoma, Paul S. Massimiano, Frederick C. Lough, Eric A. Elster

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Although there is a clear volume–outcome relationship in the field of cardiac surgery, the existence of high-performing programs with relatively low case volumes is well established. This report describes the programmatic and institutional processes in place at a lower volume cardiac surgery center in a US military hospital, which have been executed to optimally leverage available resources in the delivery of exemplary patient care. By implementing a highly collaborative practice, rigorous outcomes review, evidence-based standardized care pathways, consistent attending surgeon oversight for care delivery, careful case selection, and a mechanism for support from highly experienced outside cardiac surgeons, the cardiac surgery program at the authors’ institution delivers care on par with its higher volume counterparts. A review of these practices and available supporting evidence may provide a model for other programs seeking success in this setting.

Original languageEnglish
Pages (from-to)426-433
Number of pages8
JournalAmerican Journal of Medical Quality
Issue number4
StatePublished - 1 Jul 2018
Externally publishedYes


  • cardiac surgical procedures
  • heart diseases
  • physicians’ practice patterns
  • quality of health care


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