Impact of International Quality Improvement Collaborative on Congenital Heart Surgery in Pakistan

AbstractBackgroundFlorida is the fourth largest state in the United States of America. In 2004, 218,045 live babies were born in Florida, accounting for approximately 1744 new cases of congenital heart disease. We review the initial experience of The Society of Thoracic Surgeons Congenital Heart Surgery Database with a regional outcomes report, namely the Society of Thoracic Surgeons Florida Regional Report.MethodsEight centres in Florida provide services for congenital cardiac surgery. The Children’s Medical Services of Florida provide a framework for quality improvement collaboration between centres. All congenital cardiac surgical centres in Florida have voluntarily agreed to submit data to the Society of Thoracic Surgeons Database. The Society of Thoracic Surgeons and Duke Clinical Research Institute prepared a Florida Regional Report to allow detailed regional analysis of outcomes for congenital cardiac surgery.ResultsThe report of 2007 from the Society of Thoracic Surgeons Congenital Heart Surgery Database includes details of 61,014 operations performed during the 4 year data harvest window, which extended from 2003 through 2006. Of these operations, 6,385 (10.5%) were performed in Florida. Discharge mortality in the data from Florida overall, and from each Florida site, with 95% confidence intervals, is not different from cumulative data from the entire Society of Thoracic Surgeons Database, both for all patients and for patients stratified by complexity.ConclusionsA regional consortium of congenital heart surgery centres in Florida under the framework of the Children’s Medical Services has allowed for inter-institutional collaboration with the goal of quality improvement. This experience demonstrates, first, that the database maintained by the Society of Thoracic Surgeons can provide the framework for regional analysis of outcomes, and second, that voluntary regional collaborative efforts permit the pooling of data for such analysis.

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2404The impact of the Cardiac OR I-PASS report tool on the in-hospital mortality in children undergoing congenital heart surgery: nursing quality improvement initiative

European Heart Journal ◽

10.1093/eurheartj/ehy565.2404 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

E Anikeeva ◽

I Khalivopulo ◽

D Shukevich ◽

D Borisenko ◽

O Andguladze

Keyword(s):

Quality Improvement ◽

Hospital Mortality ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Quality Improvement Initiative ◽

Nursing Quality

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Standardizing Discharge Furosemide Duration Following Congenital Heart Surgery

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/21501351211049308 ◽

2021 ◽

pp. 215013512110493

Author(s):

Mira Trivedi ◽

Carlos Eduardo Diaz-Castrillon ◽

Evonne Morell

Keyword(s):

Quality Improvement ◽

Hospital Discharge ◽

Congenital Heart ◽

Heart Surgery ◽

Average Duration ◽

Diuretic Therapy ◽

Total Duration ◽

Congenital Heart Surgery ◽

Practice Change ◽

Improvement Project

Background: Pediatric cardiothoracic surgery has evolved over the last several decades with shorter bypass times and less need for hypothermic arrest. Diuretics have been commonly used in the post-operative period with no guidelines on duration following cardiopulmonary bypass. As a result, we conducted a single-center quality improvement project to reduce overuse of diuretics in post-operative patients without causing an increase in complications. We devised an early diuretic wean protocol that was implemented upon patient discharge. Methods: All patients who underwent uncomplicated congenital heart surgery after November 2018 were considered for the protocol. We defined an early diuretic wean protocol with a total duration of ten days of single diuretic therapy following hospital discharge. Patients were evaluated in clinic two weeks following discharge, after completion of diuretic therapy, to assess for clinical symptoms and development of effusions. Results: Retrospective pre-protocol data found the average duration a patient was on diuretics was 32 days following hospital discharge from uncomplicated congenital heart surgery. Following implementation of the protocol, there was a decrease in the total duration to 14 days, demonstrating a 56% decrease. With this practice change, there was no notable increase in adverse events. Conclusions: With implementation of the protocol, practice variability was minimized and the average post-operative diuretic duration was decreased without an increase in pleural and/or pericardial effusions or readmissiosn rates. Future directions and ongoing changes include expanding to a multicenter quality improvement collaborative focusing on decreasing the average duration of furosemide to less than five days after hospital discharge.

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The World Database for Pediatric and Congenital Heart Surgery: The Dawn of a New Era of Global Communication and Quality Improvement in Congenital Heart Disease

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135117725458 ◽

2017 ◽

Vol 8 (5) ◽

pp. 597-599 ◽

Cited By ~ 9

Author(s):

James D. St. Louis ◽

Hiromi Kurosawa ◽

Richard A. Jonas ◽

Nestor Sandoval ◽

Jorge Cervantes ◽

...

Keyword(s):

Congenital Heart Disease ◽

Quality Improvement ◽

Heart Disease ◽

Information Exchange ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Improvement Program ◽

Global Improvement ◽

The World

The World Society for Pediatric and Congenital Heart Surgery was founded with the mission to “promote the highest quality comprehensive cardiac care to all patients with congenital heart disease, from the fetus to the adult, regardless of the patient’s economic means, with an emphasis on excellence in teaching, research, and community service.” Early on, the Society’s members realized that a crucial step in meeting this goal was to establish a global database that would collect vital information, allowing cardiac surgical centers worldwide to benchmark their outcomes and improve the quality of congenital heart disease care. With tireless efforts from all corners of the globe and utilizing the vast experience and invaluable input of multiple international experts, such a platform of global information exchange was created: The World Database for Pediatric and Congenital Heart Disease went live on January 1, 2017. This database has been thoughtfully designed to produce meaningful performance and quality analyses of surgical outcomes extending beyond immediate hospital survival, allowing capture of important morbidities and mortalities for up to 1 year postoperatively. In order to advance the societal mission, this quality improvement program is available free of charge to WSPCHS members. In establishing the World Database, the Society has taken an essential step to further the process of global improvement in care for children with congenital heart disease.

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Pulmonary Vein Stenosis: A Rare Disease with a Global Reach

Children ◽

10.3390/children8030198 ◽

2021 ◽

Vol 8 (3) ◽

pp. 198

Author(s):

Jennifer Schramm ◽

Sivakumar Sivalingam ◽

Guillermo E. Moreno ◽

Dinh Quang Le Thanh ◽

Kimberlee Gauvreau ◽

...

Keyword(s):

Quality Improvement ◽

Pulmonary Vein ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Pulmonary Vein Stenosis ◽

Middle Income ◽

Improvement Project ◽

Low Middle Income Countries ◽

Vein Stenosis

Pulmonary vein stenosis (PVS) is a rare, but high mortality and resource intensive disease caused by mechanical obstruction or intraluminal myofibroproliferation, which can be post-surgical or idiopathic. There are increasing options for management including medications, cardiac catheterization procedures, and surgery. We queried the International Quality Improvement Collaborative for Congenital Heart Disease (IQIC) database for cases of PVS and described the cohort including additional congenital lesions and surgeries as well as infectious and mortality outcomes. IQIC is a quality improvement project in low-middle-income countries with the goal of reducing mortality after congenital heart surgery. Three cases were described in detail with relevant images. We identified 57 cases of PVS surgery, with similar mortality to higher income countries. PVS should be recognized as a global disease. More research and collaboration are needed to understand the disease, treatments, and outcomes, and to devise treatment approaches for low resource environments.

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Abstract 17042: Surgery and Outcomes for Transposition of the Great Arteries among Developing World Congenital Heart Surgery Programs: a Report from the International Quality Improvement Collaborative

Circulation ◽

10.1161/circ.130.suppl_2.17042 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

David N Schidlow ◽

Kathy J Jenkins ◽

Kimberlee Gauvreau ◽

Ulisses A Croti ◽

Do Thi Cam Giang ◽

...

Keyword(s):

Risk Factors ◽

Quality Improvement ◽

Hospital Mortality ◽

Congenital Heart ◽

Heart Surgery ◽

Developing World ◽

Arterial Switch Operation ◽

Institutional Characteristics ◽

Quality Improvement Collaborative ◽

Surgical Interventions

Objectives: Surgical care for CHD in the developing world is rapidly evolving, allowing an opportunity for survival for children with previously lethal conditions. Little information is available about such patients and their outcomes. The objectives of this study were to identify (1) patient characteristics, (2) surgical interventions, (3) institutional characteristics, and (4) risk factors for mortality among patients in the International Quality Improvement Collaborative (IQIC) undergoing surgery for transposition of the great arteries (TGA) with intact ventricular septum (IVS) and TGA with ventricular septal defect (VSD). Methods: We utilized a novel international collaborative database collected by developing world congenital heart surgical programs as part of a QI project. All TGA (IVS and VSD) cases from 2010-2012 were included. Demographic, surgical and institutional characteristics and their associations with in-hospital mortality were identified. Results: There were 559 patients at 21 centers who underwent surgery for TGA: 348 TGA/IVS and 211 TGA/VSD. TGA/IVS patients underwent arterial switch operation (ASO), 282 (81%); 2-stage ASO, 24 (7%); and atrial switch (ATS) 42, (12%). TGA/VSD patients underwent ASO, 169 (80%); 2-stage ASO, 19 (9%); and ATS, 23 (11%); all with VSD closure. In-hospital mortality ranged from 10% to 25% depending on procedure (Figure). Unadjusted mortality rates were higher among centers performing <10 TGA repairs yearly (OR 3.98; 95% CI 2.08-7.60, p<0.001). Among patients with TGA/IVS who underwent primary ASO, risk factors for mortality included male gender (p=0.05), weight <3 kg (p=0.04), and prematurity (p=0.007). Conclusions: Infants with TGA in the developing world increasingly have access to complex surgical repairs, and the majority of such patients undergo single-stage ASO. Mortality remains substantial; however, multi-center collaborative QI efforts are likely to benefit these patients.

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