The Database Dilemma: An Imperfect but Critical Tool to Improve Quality and Benchmark Outcomes (Ed.)

The Society of Thoracic Surgeons (STS) database was created in 1989 as a patient safety initiative for adults undergoing cardiothoracic surgery. In 2005, pediatric and congenital cardiac patient data began being collected by a registry operated by the Congenital Cardiac Anesthesia Society. Collaboration between STS and Congenital Cardiac Anesthesia Society fostered eventual development of the Congenital Heart Surgery Database (CHSD), a specialized section within the STS database. The STS CHSD collects data to provide participants with risk-adjusted outcomes information to allow for improvement in individual surgical or program components. The STS predated meaningful use of electronic health records (EHRs), an initiative encouraging health organizations to move from anecdotal-based evidence to systems-based practice in decision making. The meaningful use mandate accompanied widespread adoption of the EHR, an administrative database allowing capture of clinical information to facilitate quality improvement.1 In parallel, sophisticated databases and patient registries such as the STS CHSD, which are housed and operated outside a given health care system, provide an opportunity to explore associations, answer clinical questions, and ensure quality care.