The performance improvement department at The Queen's Medical Center (QMC) in Honolulu, has been monitoring the outcomes of cardiovascular interventional procedures and cardiothoracic surgical procedures. By using an institution-wide database as well as participating in national cardiac databases, a set of clinical indicators is tracked, and quarterly reports are provided to the cardiovascular medicine (CV) and thoracic and cardiovascular surgery (TCV) services. After reviewing the data, a combined CV/TCV/anesthesia morbidity and mortality committee meets monthly to further evaluate the data, review cases, and formulate action plans based upon the findings. Using these tools and methods, we have seen a marked improvement in clinical outcomes among cardiac patients.