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

Khan, Aijaz Ahmed; Abdullah, Ahmed; Ahmad, Hayat; Rizvi, Arjumand; Batool, Sehrish; Jenkins, Kathy J.; Gauvreau, Kimberlee; Amanullah, Muneer; Haq, Anwar Ul; Aslam, Nadeem; Minai, Fauzia; Hasan, Babar

doi:10.1136/heartjnl-2016-310533

Cited by 47 publications

(45 citation statements)

References 22 publications

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“…Like other CCLs in LMICs, the experience at AKUH prior to joining the collaborative demonstrated several system-level issues including inadequate documentation, inadequate tracking of procedural outcomes, lack of staff interest in congenital cases and improper radiation safety measures (both for patient and staff) 25–28. The success of IQIC in highlighting CHD surgeries in LMICs and significantly improving postoperative morbidity and mortality in patients with CHD is an excellent example of the effectiveness of collaboration between developed and LMIC CHD programmes 9. System-level changes (nurse empowerment, QI teams, systematic data tracking, and so on) and improved practices (surgical checklist, infection control, and so on) were some of the key factors in determining the success of IQIC in our CHD surgical programme 9.…”

Section: Discussionmentioning

confidence: 99%

“…The success of IQIC in highlighting CHD surgeries in LMICs and significantly improving postoperative morbidity and mortality in patients with CHD is an excellent example of the effectiveness of collaboration between developed and LMIC CHD programmes 9. System-level changes (nurse empowerment, QI teams, systematic data tracking, and so on) and improved practices (surgical checklist, infection control, and so on) were some of the key factors in determining the success of IQIC in our CHD surgical programme 9. We joined C3PO-QI with the intention of not just targeting radiation improvement but to bring about a system-level change in the CCL.…”

Section: Discussionmentioning

confidence: 99%

“…Such risk adjustment provides an opportunity for fair comparison among centres and purposeful QI initiatives. The C3PO-QI recently showed that DAP indexed to weight (DAP/kg) provides an acceptable adjustment of outcomes, accounting for the variability in dose seen among cases of varying patient sizes 9. Similarly, risk stratification of radiation exposure based on procedural complexity and patient size has been proposed (manuscript in review) in which 90% of procedures performed in nine centres of the C3PO-QI collaborative were categorised into three radiation exposure categories: low (<100 µGy-M 2 /kg), medium (100–200 µGy-3 M 2 /kg) and high (>200 µGy-M 2 /kg).…”

Section: Methodsmentioning

confidence: 99%

“…Experience from the International Quality Improvement Collaborative (IQIC) has also shown significant improvement in outcomes related to CHD surgeries in low/middle-income countries (LMIC), illustrating the success of collaboratives between developed countries and LMICs 9. A significant number of patients with CHD in LMICs who undergo CHD surgery also undergo cardiac catheterisation.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in LMICs

et al. 2019

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BackgroundThe importance of registries for collaborative quality improvement has been overlooked in low/middle-income countries (LMIC). Aga Khan University Hospital (AKUH) in Pakistan joined the Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in March 2017 with the goal of leveraging international collaboration to improve patient care and institutional standards.MethodsThe C3PO-QI key driver-based approach was used, with certain modifications, for process re-engineering in AKUH’s congenital cardiac catheterisation laboratory (CCL) to reduce radiation exposure during cardiac catheterisation procedures (the primary outcome of C3PO- QI). Educating staff and standardising procedural documentation were the principal goals of the process re-engineering. Data survey was used to assess staff knowledge, attitude and practice before and after the initiative. Additionally, case demographics and outcomes were compared between AKUH and C3PO-QI centres.ResultsThere was an increase in appropriate recording of radiation surrogates (0%–100%, p=0.00) and in the percentage of cases that met the established benchmark of ‘Ideal documentation’ (35% vs 95%, p=0.001). There was also an increase in self-reported staff interest during the case (25% vs 75%, p=0.001). AKUH versus C3PO-QI data showed similar demographic characteristics. There was a slight over-representation of diagnostic cases (42% vs 32%) as compared with interventional (58% vs 68%) at AKUH. Furthermore, interventional procedures were predominately PDA and ASD device closures (n=19 and 15, respectively). The frequency of adverse events were the same between AKUH and collaborative sites.ConclusionCollaborative efforts between developed and LMIC CCL are significant in advancing system-level processes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in LMICs

et al. 2019

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“…The Heart paper by Khan and colleagues4 is a welcome addition to the literature as it highlights the advantages, as well as limitations, of applying some of the recommendations of a collaborative programme developed by workers at Boston Children Hospital, and currently being applied completely, or in part, by 28 centres in low/middle-income countries 5. The authors report the effect of applying some of these recommendations, including enhancing hospital infection control and nurse empowerment to lead multidisciplinary teams on short-term outcome.…”

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confidence: 99%

Improving postoperative outcome of congenital heart surgery in low/middle-income countries: climbing mount excellence

Yacoub

Hosny

Afifi

2017

Heart

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Pilot phase experience of the International Quality Improvement Collaborative catheterization registry

Barry

Ali

Ronderos

et al. 2020

Cathet Cardio Intervent

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Objectives: To describe the development of a quality collaborative for congenital cardiac catheterization centers in low and middle-income countries (LMICs) including pilot study data and a novel procedural efficacy measure. Background: Absence of congenital cardiac catheterization registries in LMICs led to the development of the International Quality Improvement Collaborative Congenital Heart Disease Catheterization Registry (IQIC-CHDCR). As a foundation for this initiative, the IQIC is a collaboration of pediatric cardiac surgical programs from LMICs. Participation in IQIC has been associated with improved patient outcomes. Methods: A web-based registry was designed through a collaborative process. A pilot study was conducted from October through December 2017 at seven existing IQIC sites. Demographic, hemodynamic, and adverse event data were obtained and a novel tool to assess procedural efficacy was applied to five specific procedures. Procedural efficacy was categorized using ideal, adequate, and inadequate. Results: A total of 429 cases were entered. Twenty-five adverse events were reported. The five procedures for which procedural efficacy was measured represented 48% of cases (n = 208) and 71% had complete data for analysis (n = 146). Procedure efficacy was ideal most frequently in patent ductus arteriosus (95%) and atrial septal defect (90%) device closure, and inadequate most frequently in coarctation procedures (100%), and aortic and pulmonary valvuloplasties (50%). Conclusions: The IQIC-CHDCR has designed a feasible collaborative to capture catheterization data in LMICs. The novel tool for procedural efficacy will provide valuable means to identify areas for quality improvement. This pilot study and lessons learned culminated in the full launch of the IQIC-CHDCR.

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

Abstract: Enrolling in the IQIC programme was associated with an improvement in the postsurgical outcomes of the CHD surgeries at our centre.

Cited by 47 publications

References 22 publications

Impact of Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in LMICs

Impact of Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in LMICs

Improving postoperative outcome of congenital heart surgery in low/middle-income countries: climbing mount excellence

Pilot phase experience of the International Quality Improvement Collaborative catheterization registry

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