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Abstract: The opinions in this paper were originally requested by The Mid-Staffordshire Public Inquiry in the United Kingdom. 1 [1] http://www.midstaffspublicinquiry.com/. This inquiry has highlighted the way in which Boards of Hospitals may fail to use information correctly in several ways; inappropriate collection, poor validation, lack of appropriate analysis and the absence of transparency. Here I outline some personal opinions based on long experience at the coal-face of both medicine and information management. Whilst many of the examples I have chosen reflect life the in the UK National Health Service, they are widely applicable internationally. Data drive change, and I argue that healthcare has become an information economy. Purchasers and users of care can drive the demand for better data, but the underlying infrastructure requires adequate funding. I also argue that outcome measurement alone is not enough, and that quality control offers faster, more effective improvement through the transformation cycle. The technology available to us now gives us fresh and exciting opportunities to engage with our patients and to share information with those who need it. Anyone bringing their precious child to a hospital has a right to know about the quality, safety and outcomes they can expect. We have a duty to give those data to them. [Copyright &y& Elsevier]

Discusses the use of non-heart-beating donors for lung transplantation in the United Kingdom. Study published in the March 17, 2001 issue of the periodical 'Lancet;' Benefits of the research, including increased donor supply; Issues raised by the paper, including consensus on the ethics of the procedure; Feeling that units with patients who are potential donors must be prepared to revise their thinking to allow the procedures for organ preservation and retrieval and detailed functional assessment of the organ; Shortcomings of the paper.

Abstract: Objective: Fast-track patient pathways for cardiac surgery are used in adult practice and by necessity is a mainstay in the developing world. We aimed to introduce a fast-track protocol for uncomplicated paediatric open-heart surgery cases and to subsequently review the results of this change in practice. Methods: A fast-track protocol co-ordinated by the Advanced Nurse Practitioners was introduced in January 2006 for children aged over 6 months undergoing uncomplicated open-heart procedures. We conducted a review of prospectively collected data on all included patients. The setting was a tertiary paediatric cardiac surgical centre in the UK. The outcome measures for audit were: patient fitness to leave the intensive care unit (ICU) on the day of surgery and hospital length of stay. Results: Included children had a mean age 6 (standard deviation (SD) 4.9) years and mean weight 22.7 (SD 17.6) kg. Of the 194 patients included, 153 (79%) were fit to leave the ICU on the day of surgery. Patients undergoing surgery for ventricular septal defect: odds ratio (OR) 2.8 (95% CI: 1.2–5.6) P =0.01 and left ventricular outflow tract obstruction: OR 5.5 (95% CI: 1.4–21.2) P =0.01, were more likely to be unfit than atrial septal defect and right ventricular outflow tract obstruction. Patients undergoing surgery in the afternoon were more likely to be unfit than those undergoing surgery in the morning: OR 2.3 (95% CI: 1.2–4.8) P =0.03. No relationship was found between age or weight and fitness to fast track. Median length of hospital stay for the whole cohort was 3 (range: 2–11) days. After adjustment for case mix, there was significant evidence that length of hospital stay reduced as experience with the protocol increased over the series of patients RC −0.02 (95% CI: −0.01 to −0.03) P <0.01. Conclusion: A fast-track programme can be implemented safely and effectively if the appropriate support including a step-down ward area is put in place. Greater experience with this type of protocol leads to reductions in the length of hospital stay for children aged over 6 months undergoing uncomplicated open-heart surgery. Fast-track cases should be performed in the morning. [Copyright &y& Elsevier]