Current functioning of cardio-oncology units in Spain.

PURPOSE: The aim of the current survey was to describe the functioning of cardio-oncology (C-O) units in Spain. METHODS: All members of the Spanish Society of Cardiology pertaining to scientific communities related to C-O received questionnaires on the existence of specific programs at their institutions. A second, more extensive questionnaire was sent to the centers which reported C-O organization. RESULTS: We identified 56 centers with C-O programs of which 32 (62.5%) replied to the extended questionnaire. 28% of all centers reported having a multidisciplinary unit involving specialists in several areas. More than 80% of the centers developed surveillance protocols locally adapted which included advanced echocardiographic techniques (68%) or troponin (82%). CONCLUSIONS: The number of institutions with C-O programs is still limited but higher than reported in a survey in 2017. Development of multidisciplinary units of C-O should be promoted to improve the cardiovascular health of cancer patients.

Análisis de la cultura de seguridad en una Unidad de Cardiología gestionada por procesos / Analysis of the safety culture in a Cardiology Unit managed by processes

Resumen La cultura sobre seguridad se perfila como uno de los requisitos para evitar la aparición de efectos adversos, sin embargo, no se ha estudiado en el ámbito de la cardiología. Objetivo: es evaluar la cultura de seguridad en una unidad de cardiología que tiene implantado y certificado un sistema integrado de gestión de calidad y riesgos para la seguridad del paciente. Método: Se realizó un estudio observacional trasversal en 2 años consecutivos utilizando la encuesta Hospital Survey on Patient Safety Culture de la «Agency for Healthcare Research and Quality¼ en su versión española (42 ítems agrupados en 12 dimensiones) sobre todo el personal. Se comparó el porcentaje de respuestas positivas de cada dimensión en 2014 y 2015, así como con los datos a nivel nacional y en EE. UU., siguiendo las recomendaciones establecidas. Resultados: La valoración global, sobre un máximo de 5, fue de 4.5 en 2014 y de 4.7 en 2015. Identificamos 7 dimensiones como fortaleza. Las peor valoradas fueron: Dotación de personal, Apoyo de la gerencia y Trabajo en equipo entre unidades. La comparación mostró superioridad en todas las dimensiones a nivel nacional, y en 8 respecto a los datos del registro americano. Conclusiones: La cultura de seguridad en una unidad de cardiología con un sistema integrado de gestión de calidad y riesgos y seguridad del paciente es elevada, superior a la nacional en todas sus dimensiones y en la mayoría de ellas respecto al registro de EE. UU.

Abstract Safety culture is one of the requirements for preventing the occurrence of adverse effects. However, this has not been studied in the field of cardiology. The aim of this study is to evaluate the safety culture in a cardiology unit that has implemented and certified an integrated quality and risk management system for patient safety. Methods: A cross-sectional observational study was conducted in 2 consecutive years, with all staff completing the Spanish version of the questionnaire, ''Hospital Survey on Patient Safety Culture'' of the ''Agency for Healthcare Research and Quality'', with 42 items grouped into 12 dimensions. The percentage of positive responses in each dimension in 2014 and 2015 were compared, as well as national data and United States data, following the established rules. Results: The overall assessment out of a possible 5, was 4.5 in 2014 and 4.7 in 2015. Seven dimensions were identified as strengths. The worst rated were: staffing, management support and teamwork between units. The comparison showed superiority in all dimensions compared to national data, and in 8 of them compared to American data. Conclusions: The safety culture in a Cardiology Unit with an integrated quality and risk management patient safety system is high, and higher than nationally in all its dimensions and in most of them compared to the United States.

[Analysis of the safety culture in a Cardiology Unit managed by processes]. / Análisis de la cultura de seguridad en una Unidad de Cardiología gestionada por procesos.

Safety culture is one of the requirements for preventing the occurrence of adverse effects. However, this has not been studied in the field of cardiology. The aim of this study is to evaluate the safety culture in a cardiology unit that has implemented and certified an integrated quality and risk management system for patient safety. METHODS: A cross-sectional observational study was conducted in 2 consecutive years, with all staff completing the Spanish version of the questionnaire, "Hospital Survey on Patient Safety Culture" of the "Agency for Healthcare Research and Quality", with 42 items grouped into 12 dimensions. The percentage of positive responses in each dimension in 2014 and 2015 were compared, as well as national data and United States data, following the established rules. RESULTS: The overall assessment out of a possible 5, was 4.5 in 2014 and 4.7 in 2015. Seven dimensions were identified as strengths. The worst rated were: staffing, management support and teamwork between units. The comparison showed superiority in all dimensions compared to national data, and in 8 of them compared to American data. CONCLUSIONS: The safety culture in a Cardiology Unit with an integrated quality and risk management patient safety system is high, and higher than nationally in all its dimensions and in most of them compared to the United States.

Managing educational practices for qualified nursing care in cardiology. / Gerenciando práticas educativas para o cuidado de enfermagem qualificado em cardiologia.

OBJECTIVE:: to understand significances attributed by nurses who manage nursing care to the individual affected by cardiovascular disease to relations, interactions and associations of the educational practices in a cardiovascular reference hospital. To elaborate a theoretical explanatory model based on significances attributed in the light of the complex thinking. METHOD:: qualitative study, which used Theory Based on Data (TBD) as methodological reference. Twenty-two professionals of nursing participated in the study. RESULTS:: the results indicate need of professional qualification to ensure the safety of patients, institutional support for the realization of educational practices, attitude of openness and availability of dialogue of the health professionals and other institutional conformations for the workers' development. CONCLUSION:: the study presents a new space for the nurse's action that can be used to qualify and optimize the nursing practice, as it provides visibility to management and care in health institutions.

Gerenciando práticas educativas para o cuidado de enfermagem qualificado em cardiologia / Gestionando prácticas educativas para la atención de enfermería calificada en cardiología / Managing educational practices for qualified nursing care in cardiology

RESUMO Objetivo: compreender os significados atribuídos por enfermeiros gestores do cuidado de enfermagem ao indivíduo acometido por doença cardiovascular às relações, interações e associações das práticas educativas em um hospital referência cardiovascular. Elaborar um modelo teórico explicativo com base nos significados atribuídos à luz do pensamento complexo. Método: estudo qualitativo, o qual utilizou a Teoria Fundamentada nos Dados (TFD) como referencial metodológico. Participaram do estudo 22 profissionais de enfermagem. Resultados: os resultados apontam a necessidade de qualificação profissional para garantia da segurança do paciente, apoio institucional para a efetivação das práticas educativas, atitude de abertura e disponibilidade dialógica dos profissionais de saúde e de outras conformações institucionais para o desenvolvimento dos trabalhadores. Conclusão: o estudo apresenta um novo espaço de atuação para o enfermeiro que pode ser utilizado de forma a qualificar e potencializar a práxis em enfermagem, por conferir visibilidade à gestão do cuidado de enfermagem nas instituições de saúde.

RESUMEN Objetivo: comprender los significados atribuidos por enfermeros gestores de atención de enfermería al paciente de enfermedad cardiovascular respecto de relaciones, interacciones y asociaciones de prácticas educativas en hospital cardiovascular de referencia. Elaborar modelo teórico explicativo basado en los significados atribuidos a la luz del pensamiento complejo. Método: estudio cualitativo, utilizando la Teoría Fundamentada en los Datos (TFD) como referencial metodológico. Participaron 22 profesionales de enfermería. Resultados: los resultados expresan la necesidad de calificación profesional para garantizar la seguridad del paciente, apoyo institucional para hacer efectivas las prácticas educativas, actitud de apertura y disponibilidad dialógica de los profesionales de salud y de otros sectores institucionales para el desarrollo de los trabajadores. Conclusión: el estudio presenta un nuevo espacio de actuación para el enfermero, que puede utilizarse apuntando a calificar y potenciar la praxis en enfermería, por otorgarle visibilidad a la gestión de la atención de enfermería en las instituciones de salud.

ABSTRACT Objective: to understand significances attributed by nurses who manage nursing care to the individual affected by cardiovascular disease to relations, interactions and associations of the educational practices in a cardiovascular reference hospital. To elaborate a theoretical explanatory model based on significances attributed in the light of the complex thinking. Method: qualitative study, which used Theory Based on Data (TBD) as methodological reference. Twenty-two professionals of nursing participated in the study. Results: the results indicate need of professional qualification to ensure the safety of patients, institutional support for the realization of educational practices, attitude of openness and availability of dialogue of the health professionals and other institutional conformations for the workers' development. Conclusion: the study presents a new space for the nurse's action that can be used to qualify and optimize the nursing practice, as it provides visibility to management and care in health institutions.

Electronic medical record in cardiology: a 10-year Italian experience.

OBJECTIVES: the aim of this study was to report a ten years experience in the electronic medical record (EMR) use. An estimated 80% of healthcare transactions are still paper-based. METHODS: an EMR system was built at the end of 1998 in an Italian tertiary care center to achieve total integration among different human and instrumental sources, eliminating paper-based medical records. Physicians and nurses who used EMR system reported their opinions. In particular the hospital activity supported electronically, regarding 4,911 adult patients hospitalized in the 2004- 2008 period, was examined. RESULTS: the final EMR product integrated multimedia document (text, images, signals). EMR presented for the most part advantages and was well adopted by the personnel. Appropriateness evaluation was also possible for some procedures. Some disadvantages were encountered, such as start-up costs, long time required to learn how to use the tool, little to no standardization between systems and the EMR technology. CONCLUSION: the EMR is a strategic goal for clinical system integration to allow a better health care quality. The advantages of the EMR overcome the disadvantages, yielding a positive return on investment to health care organization.

Electronic medical record in cardiology: a 10-year Italian experience / Registros médicos eletrônicos em cardiologia: uma experiência italiana em 10 anos

SummaryObjectives:the aim of this study was to report a ten years experience in the electronic medical record (EMR) use. An estimated 80% of healthcare transactions are still paper-based.Methods:an EMR system was built at the end of 1998 in an Italian tertiary care center to achieve total integration among different human and instrumental sources, eliminating paper-based medical records. Physicians and nurses who used EMR system reported their opinions. In particular the hospital activity supported electronically, regarding 4,911 adult patients hospitalized in the 2004- 2008 period, was examined.Results:the final EMR product integrated multimedia document (text, images, signals). EMR presented for the most part advantages and was well adopted by the personnel. Appropriateness evaluation was also possible for some procedures. Some disadvantages were encountered, such as start-up costs, long time required to learn how to use the tool, little to no standardization between systems and the EMR technology.Conclusion:the EMR is a strategic goal for clinical system integration to allow a better health care quality. The advantages of the EMR overcome the disadvantages, yielding a positive return on investment to health care organization.

ResumoObjetivos:o objetivo deste estudo foi relatar uma experiência de 10 anos de utilização de registro médico eletrônico (EMR). Estima-se que 80% das transações na saúde ainda são feitas em papel.Métodos:um sistema de EMR foi implementado ao final de 1998, em um centro italiano de cuidados terciários, com o objetivo de alcançar uma total integração entre diferentes recursos humanos e instrumentais, eliminando registros médicos em papel. Médicos e enfermeiros que utilizaram o sistema EMR relataram suas opiniões. Foi analisada a atividade hospitalar amparada eletronicamente relacionada a 4.911 pacientes adultos hospitalizados, no período de 2004 a 2008.Resultados:o produto final do EMR integra documentos com recursos de multimídia (texto, imagens, sinais). O EMR apresentou predominantemente vantagens e foi bem adotado pelos profissinais. A avaliação de adequação também foi possível em alguns procedimentos. Algumas desvantagens foram encontradas, como os custos de instalação, longo período de aprendizado para uso, pouca ou nenhuma padronização entre os sistemas EMR. Conclusões: o EMR é um objetivo estratégico para a integração do sistema de clínica e para permitir uma melhor qualidade de cuidados de saúde. As vantagens do EMR superam as desvantagens, produzindo um retorno positivo desse investimento para a instituição de saúde.Conclusões:o EMR é um objetivo estratégico para a integração do sistema de clínica e para permitir uma melhor qualidade de cuidados de saúde. As vantagens do EMR superam as desvantagens, produzindo um retorno positivo desse investimento para a instituição de saúde.

Análisis integral de la unidad cardiovascular del Hospital de Niños de la Santísima Trinidad / Comprehensive analysis of the cardiovascular unit at Children's Hospital of the Holy Trinity

El siguiente es un análisis descriptivo de la UNIDAD CARDIOVASCULAR DEL HOSPITAL DE NIÑOS DE LA SANTISIMA TRINIDAD CORDOBA-2013 (UCV-HNST) ,en donde se intenta mostrar con estadísticas la necesidad de aumentar el número de cirugías cardiovasculares en córdoba, tanto a nivel público como privado para poder disminuir una de las cinco primeras causas de mortalidad infantil en la actualidad , que como intentaremos demostrar es altamente evitable ,si estos niños son tratados en tiempo y forma por profesionales capacitados. Para ello analizamos la situación de las cirugías cardiovasculares en córdoba con respecto al país y luego observamos específicamente el funcionamiento de la UCVHNST y se propone una reestructuración del mismo para poder aumentar el número de cirugías y hemodinamias de dicho nosocomio, con el objetivo de disminuir la actual lista de espera de niños con cardiopatías congénitas quirúrgicas

SUMMARY: The following descriptive analysis of UNIT CARDIOVASCULAR HOSPITAL FOR CHILDREN OF THE HOLY TRINITY CORDOBA-2013 (UCV-HNST), we intend to show statistics the need to increase the number of cardiovascular surgeries in Cordoba, both public and private to to reduce one of the five leading causes of infant mortality today, and try to show that it is highly preventable if these children are treated in a timely manner by trained professionals. We analyzed the situation of cardiovascular surgeries in Cordoba over the country and then specifically at the functioning of the UCV-HNST and restructuring of it is proposed to increase the number of surgeries and hemodynamics of the hospital, with the aim of reduce the current waiting list of children with congenital heart surgery

[Interhospital transfer of ECMO-assisted patients in Martinique]. / Transfert interhospitalier sous assistance circulatoire extracorporelle (ECMO): l'expérience martiniquaise.

OBJECTIVE: The transportation of critically ill patients in the French West Indies represents a real challenge; in order to ensure territorial continuity of health care provision, the cardiac surgical department of the Fort-de-France Hospital created a mobile ECMO/ECLS unit. The aim of our work is to describe the logistical, technical and financial aspects of the interhospital transfer of ECMO/ECLS-assisted patients in the French Caribbean. PATIENTS AND METHODS: All ECMO/ECLS-assisted patients in the French Antilles-Guyane area subsequently repatriated towards the Fort-de-France Hospital were included from December 29th, 2009 to September 30th, 2011. Indication and type of the extracorporeal assistance used, location of departure, type of transport vehicle, complications during transfer, survival after hospital discharge and direct costs were collected. RESULTS: Nineteen patients were supported by our mobile unit far away from our centre (sex-ratio 0.63, median age 34years old [16-64]). Twelve were assisted by ECMO for a refractory ARDS, and seven were assisted by ECLS for a refractory cardiogenic shock. Four patients were transferred by ambulance (7-29km), seven by helicopter (190-440km), and eight by plane (440-1430km). No patient died during transfer. No major adverse event occurred during these transfers. Fifteen patients survived. An economic assessment was conducted. CONCLUSION: Interhospital transfer of ECMO/ECLS-assisted patients by land or air is technically feasible under perfectly secure conditions in our area. Prior coordination of this activity has helped to make it affordable.

Integrated regional networks for ST-segment-elevation myocardial infarction care in developing countries: the experience of Salvador, Bahia, Brazil.

BACKGROUND: Regionalized integrated networks for ST-segment-elevation myocardial infarction (STEMI) care have been proposed as a step forward in overcoming real-world obstacles, but data are lacking on its performance in developing countries. We describe an integrated regional STEMI network in Salvador, Bahia, Brazil. METHODS AND RESULTS: The network was created in 2009. It was coordinated by the prehospital emergency medical service and encompassed the public emergency system (prehospital mobile units, community-based emergency units, general hospitals, and cardiology reference centers). The 12-lead ECGs are interpreted via telemedicine. This network operates as follows: The Telemedicine Center sends each ECG suggestive of STEMI to a Regional STEMI Alert Team, which, together with emergency medical services, offers support for thrombolysis or immediate transfer for primary percutaneous coronary intervention. In 14 months, there were 433 suspected victims, of which in 287 (76.5%) the STEMI could be confirmed (age, 62.1±12.5 years; 63.4% men). Most of them were self-transported. The median pain-to-admission time was 180 minutes (interquartile range, 90-473 minutes), and the median admission-to-ECG time was 159.5 minutes (interquartile range, 83.5-340 minutes). The median interval time between the ECG and the telemedicine report was 31 minutes (interquartile range, 21-44 minutes). For those who sought medical attention and had an ECG performed within 12 hours after symptoms onset (n=119), the reperfusion rate was 75.6% (34.4% by thrombolysis and 65.6% by primary percutaneous coronary intervention). CONCLUSIONS: Regional STEMI networks may be feasible in developing countries. Preliminary results showed this network to be effective, achieving primary reperfusion rtes comparable with those reported internationally despite the obstacles faced.

The provision of surgical care for children with cardiac disease: the Jamaican experience--an 18-year review.

The aim of this article is to review the local experience over the last 18 years (1994-2011) in providing surgical intervention for children with heart conditions in Jamaica. Eight hundred and sixty-three children received cardiac surgery during this period, 441 were done with the assistance of visiting overseas teams and 422 by the local surgical teams. The majority of cases receiving cardiac surgery were for congenital heart defects; however 3% of cases were for rheumatic heart disease. The overall survival rate was 94% for the period 1994 to 2008.

The provision of surgical care for children with cardiac disease: the Jamaican experience - An 18-year review / La provisión de la atención quirúrgica a niños con la enfermedad cardíaca: un estudio de 18 años

The aim of this article is to review the local experience over the last 18 years (1994-2011) in providing surgical intervention for children with heart conditions in Jamaica. Eight hundred and sixty-three children received cardiac surgery during this period, 441 were done with the assistance of visiting overseas teams and 422 by the local surgical teams. The majority of cases receiving cardiac surgery were for congenital heart defects; however, 3% of cases were for rheumatic heart disease. The overall survival rate was 94% for the period 1994 to 2008.

El objetivo de este artículo es pasar examen a la experiencia local durante los últimos 18 años (1994-2011) en cuanto a brindar intervención quirúrgica a niños con problemas cardíacos en Jamaica. Ochocientos sesenta y tres niños recibieron cirugía cardíaca durante este periodo. De estas, 441 se realizaron con ayuda de equipos formados por personal médico visitante extranjero, y 422 por equipos de cirujanos locales. La mayoría de los casos que recibieron cirugía cardíaca presentaban defectos cardíacos congénitos. Sin embargo, un 3% de los casos presentaban la enfermedad reumática del corazón. La tasa de supervivencia global fue 94% para el periodo 1994 a 2008.

Transradial percutaneous coronary intervention without on-site cardiac surgery for stable coronary disease and myocardial infarction: preliminary report and initial experience in 174 patients.

BACKGROUND: On-site cardiac surgery is not widely available in developing countries despite a high prevalence of coronary artery disease. OBJECTIVES: To analyze the safety, feasibility and cost-effectiveness of transradial percutaneous coronary intervention without on-site cardiac surgery in a community hospital in a developing country. METHODS: Of the 174 patients who underwent PCI for the first time in our center, we analyzed two groups: stable coronary disease and acute myocardial infarction. The primary endpoint was the rate of complications during the first 24 hours after PCI. We also analyzed the length of hospital stay and the rate of hospital readmission in the first week after PCI, and compared costs between the radial and femoral approaches. RESULTS: The study group comprised 131 patients with stable coronary disease and 43 with acute MI. Among the patients with stable coronary disease 8 (6.1%) had pulse loss, 12 (9.16%) had on-site hematoma, and 3 (2.29%) had bleeding at the site of the puncture. Among the patients with acute MI, 3 (6.98) had pulse loss and 5 (11.63%) had bleeding at the site of the puncture. There were no cases of atriovenous fistula or nerve damage. In the stable coronary disease group, 130 patients (99%) were discharged on the same day (2.4 +/- 2 hours). In the acute MI group, the length of stay was 6.6 +/- 2.5 days with at least 24 hours in the intensive care unit. There were no hospital readmissions in the first week after the procedure. The total cost, which includes equipment related to the specific approach and recovery room stay, was significantly lower with the radial approach compared to the femoral approach (US$ 500 saving per intervention). CONCLUSIONS: The transradial approach was safe and feasible in a community hospital in a developing country without on-site cardiac surgery backup. The radial artery approach is clearly more cost-effective than the femoral approach.

Results of the establishment of an organizational model in a cardiovascular surgery service.

OBJECTIVE: Increasing complexity of patients referred to cardiac surgery demands more effective heart centers, in order to maintain the same quality. The aim of this study is to examine the short-term effect of adoption of an organizational model on surgical outcomes. METHODS: From January 2006 to June 2007, 367 consecutive adult patients underwent cardiovascular surgery. Pre-, intra- and postoperative data were prospectively collected and transferred to an institutional database. Organizational model was established in August 2006, and based on integrated multiprofessional team work patient-centered, evidence-based medicine with standardized patient care and personal conflict management. The outcomes studied were hospital mortality and combined adverse events (death, stroke, acute myocardial infarction and acute renal failure), by using multivariate logistic regression analysis. RESULTS: After establishment of such model, there was reduction of hospital mortality (from 12% to 3.6%, relative risk= 0.3; P=0.003) and combined events (from 22% to 15%, relative risk=0.68; P=0.11). Operations performed previously to the model were independently associated with higher mortality (OR=2.5; P=0.04), adjusted to preoperative characteristics and Euroscore risk stratification system. Other predictors of mortality were age > 65 years (OR=6.36; 95%CI 2.57 - 17.21; P<0.0001) and cardiopulmonary bypass time > 145 minutes (OR=8.57; 95%CI 3.55 - 21.99; P<0.0001). CONCLUSION: Marked improvements in surgical outcomes depend on development of cardiac surgery centers based on organizational models similar to the model proposed in this study.

Resultados da implementação de modelo organizacional de um serviço de cirurgia cardiovascular / Results of the establishment of an organizational model in a cardiovascular surgery service

OBJETIVO: A crescente complexidade de pacientes encaminhados a cirurgia cardíaca exige maior eficiência dos serviços que prestam assistência, no sentido de manter a mesma qualidade. O objetivo é examinar o impacto, em curto prazo, da adoção de um modelo organizacional nos resultados cirúrgicos. MÉTODOS: No período entre janeiro de 2006 a junho de 2007, 367 pacientes adultos consecutivos foram submetidos à cirurgia cardiovascular. Os dados pré, intra e pós-operatórios foram colhidos prospectivamente e armazenados em um banco de dados institucional. Modelo organizacional foi implementado em agosto de 2006 e se baseou em trabalho multiprofissional integrado centralizado no paciente, medicina baseada em evidências com condutas padronizadas e resolução de conflitos interpessoais. Os desfechos estudados foram mortalidade hospitalar e eventos combinados (óbito, acidente vascular cerebral, infarto agudo do miocárdio e insuficiência renal aguda), por meio de regressão logística multivariada. RESULTADOS: Após a adoção do modelo, houve redução da mortalidade hospitalar (de 12 por cento para 3,6 por cento, risco relativo= 0,3; P=0,003) e de eventos combinados (de 22 por cento para 15 por cento, risco relativo= 0,68; P=0,11). Operações realizadas anteriormente à implementação do modelo estiveram associadas independentemente com maior mortalidade (OR=2,5; P=0,04), ajustada para características préoperatórias e complexidade pelo EuroSCORE. Outros preditores de mortalidade foram idade > 65 anos (OR=6,36; IC95 por cento 2,57 - 17,21; P<0,0001) e o tempo de circulação extracorpórea > 145 minutos (OR=8,57; IC95 por cento 3,55 - 21,99; P<0,0001). CONCLUSÃO: A rápida melhora dos resultados cirúrgicos depende da composição de serviços de cirurgia cardíaca embasados em modelos organizacionais semelhantes ao proposto.

OBJECTIVE: Increasing complexity of patients referred to cardiac surgery demands more effective heart centers, in order to maintain the same quality. The aim of this study is to examine the short-term effect of adoption of an organizational model on surgical outcomes. METHODS: From January 2006 to June 2007, 367 consecutive adult patients underwent cardiovascular surgery. Pre-, intra- and postoperative data were prospectively collected and transferred to an institutional database. Organizational model was established in August 2006, and based on integrated multiprofessional team work patient-centered, evidence-based medicine with standardized patient care and personal conflict management. The outcomes studied were hospital mortality and combined adverse events (death, stroke, acute myocardial infarction and acute renal failure), by using multivariate logistic regression analysis. RESULTS: After establishment of such model, there was reduction of hospital mortality (from 12 percent to 3.6 percent, relative risk= 0.3; P=0.003) and combined events (from 22 percent to 15 percent, relative risk=0.68; P=0.11). Operations performed previously to the model were independently associated with higher mortality (OR=2.5; P=0.04), adjusted to preoperative characteristics and Euroscore risk stratification system. Other predictors of mortality were age > 65 years (OR=6.36; 95 percentCI 2.57 - 17.21; P<0.0001) and cardiopulmonary bypass time > 145 minutes (OR=8.57; 95 percentCI 3.55 - 21.99; P<0.0001). CONCLUSION: Marked improvements in surgical outcomes depend on development of cardiac surgery centers based on organizational models similar to the model proposed in this study.

ACKNOWLEDGE: a tool to support knowledge capturing.

Knowledge management enhances organizational competitive advantages by supporting the capture, maintenance and communication of the business processes knowledge to organization members. ACKNOWLEDGE is a tool that supports tacit and explicit knowledge capturing. Organization members can use this tool to exteriorize knowledge related to organizational processes activities. The acquired knowledge is filtered, packed and stored into the organizational memory in order to be reused by other members during processes activities execution.