Impact of the International Quality Improvement Collaborative on outcomes after congenital heart surgery: A single center experience in a developing economy

Abstract

Background:The International Quality Improvement Collaborative (IQIC) for Congenital Heart Surgery in Developing Countries was initiated to decrease mortality and major complications after congenital heart surgery in the developing world.Objective:We sought to assess the impact of IQIC on postoperative outcomes after congenital heart surgery at our institution.Methods:The key components of the IQIC program included creation of a robust worldwide database on key outcome measures and nurse education on quality driven best practices using telemedicine platforms. We evaluated 1702 consecutive patients ≤18 years undergoing congenital heart surgery in our institute from January 2010-December 2012 using the IQIC database. Preoperative variables included age, gender, weight at surgery and surgical complexity as per the RACHS-1 model. The outcome variables included, in- hospital mortality, duration of ventilation, intensive care unit (ICU) stay, bacterial sepsis and surgical site infection.Results:The 1702 patients included 771(45.3%) females. The median age was 8 months (0.03-216) and the median weight was 6.1Kg (1-100). The overall in-hospital mortality was 3.1%, Over the three years there was a significant decline in bacterial sepsis (from 15.1%, to 9.6%, P < 0.001), surgical site infection (11.1% to 2.4%, P < 0.001) and duration of ICU stay from 114(8-999) hours to 72 (18-999) hours (P < 0.001) The decline in mortality from (4.3% to 2.2%) did not reach statistical significance.Conclusions:The inclusion of our institution in the IQIC program was associated with improvement in key outcome measures following congenital heart surgery over a three year period.

Perioperative complications in a paediatric cardiac surgery program with limited systemic resources

“…We attribute this result to the active implementation of infection control protocol and hand hygiene culture in our practice in the framework of the International Quality Improvement Collaborative project IQIC. 30,31 We have demonstrated that experiencing complications after paediatric cardiac surgery is an independent risk factor for death and failure-to-rescue is the major contributor for operative mortality in a program with limited systemic resources. Identifying the patterns of perioperative complications, their nature, and significance can provide the valuable material for the development of strategies for their reduction.…”

Validation and quality measurements for STS, EuroSCORE II and a regional risk model in Brazilian patients

“…Despite these issues, some studies have demonstrated that cardiac surgery outcomes in developing countries can be reduced over time through systematic team interventions [18,25]. These interventions are particularly effective in relation to a systems-based approach, standardization, team building, consistent and accurate communication, and active management of changes and quality [26].…”

Trends in Congenital Heart Disease

“…International support for congenital cardiac services has evolved beyond the scope of medical missions and exchange programs for training, and now includes successful multinational programs to report clinical outcomes with reference to global benchmarks and to enhance those outcomes using quality improvement practice. 149 As this activity increases, it has also become clear that the Western model of cardiovascular care needs to be modified to provide additional value in social economies in which the healthcare budget is strictly limited. Studies of cardiovascular surgery in low-and middle-income countries highlight the enormous expense both to the system and to patients and their families with use of the technological infrastructure deployed to palliate and repair CHD in the West.…”