Implementation of Methodology for Quality Improvement in Pediatric Cardiac Catheterization: A Multi-center Initiative by the Congenital Cardiac Catheterization Project on Outcomes—Quality Improvement (C3PO-QI)

Cevallos, Priscila; Rose, Molly J.; Armsby, Laurie B.; Armstrong, Aimee K.; El‐Said, Howaida; Foerster, Susan; Glatz, Andrew C.; Goldstein, Bryan H.; Hainstock, Michael; Kreutzer, Jacqueline; Latson, Larry; Leahy, Ryan; Petit, Christopher J.; Torres, Alejandro; Shahanavaz, Shabana; Zampi, Jeffrey D.; Bergersen, Lisa

doi:10.1007/s00246-016-1454-z

Cited by 23 publications

(17 citation statements)

References 10 publications

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“…Allen et al 20 have recognised the difficulties in establishing reliable clinical and laboratory services for thalassaemia in resource-limited countries and have recommended QI approaches as a solution to improve care of those suffering with this disease. Further, quality initiative collaborative like ours are useful for monitoring assessment, management and clinical outcomes across different centres 14 21…”

Section: Discussionmentioning

confidence: 99%

“…Only those patients with TDT undergoing a T2* CMR were included. A key driver diagram (figure 1) (similar to those used in Congenital Cardiac Catheterization Project on Outcomes and the International Quality Improvement Collaborative) was constructed to develop the roadmap of the drivers and interventions that would help achieve the purpose of this collaborative 14 15. The main aim of this collaborative was to improve morbidity and mortality of patients with TDT.…”

Section: Methodsmentioning

confidence: 99%

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Establishment of a thalassaemia major quality improvement collaborative in Pakistan

et al. 2019

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ObjectivesThe aim of this study was to establish multidisciplinary care for patients with transfusion-dependent thalassaemia (TDT) by creating a TDT quality improvement (QI) collaborative in a resource-constrained setting. This study presents our initial experience of creating this collaborative, the baseline characteristics of the participants, the proposed QI interventions and the outcome metrics of the collaborative.Design and settingTDT QI collaborative is a database comprising patients with TDT from four centres in Karachi, Pakistan. Study variables included symptoms of cardiac or endocrine dysfunction, physical examination including anthropometry and Tanner staging, chelation therapy, results of echocardiography, T2* cardiac MRI (CMR) and serum ferritin. The main outcome of this collaborative was improvement in TDT-related morbidity and mortality. Interventions addressing the key drivers of outcome were designed and implemented.ResultsAt the time of reporting, the total number of patients in this database was 295. Most patients reported cardiac symptoms corresponding to New York Heart Association class 2. Approximately half (52%, n=153) of the patients demonstrated severe myocardial iron overload (T2* <10 ms). Majority of the patients (58%, n=175) were not on adequate chelation therapy. There was no difference in echocardiographic measures of systolic and diastolic left ventricle among the different spectrums of iron overloaded myocardium.ConclusionUsing T2* CMR and endocrine testing, we have identified significant burden of iron siderosis in our patients with TDT. Lack of adequate iron load assessment and standardised management was observed. Interventions designed to target these key drivers of outcome are the unique part of this QI-based TDT registry.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Establishment of a thalassaemia major quality improvement collaborative in Pakistan

et al. 2019

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“…Various metrics (FT, air kerma, DAP, and so on) exist to determine the amount of radiation exposure during cardiac catheterisation 7. In pediatrics, the stochastic risk of radiation is the main concern rather than deterministic effects 4.…”

Section: Methodsmentioning

confidence: 99%

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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“…Finally, these registries are evolving to assess quality metrics in participating centers, providing benchmark goals for radiation doses for specific procedures amongst other outcomes variables. 68) The importance of these data may as yet be underestimated, considering the potential impact of radiation exposure through repeated cardiac catheterization on lifetime cancer risk in adults with congenital heart disease. 69) …”

Section: Registries Risk Calculators and Decision Makingmentioning

confidence: 99%

Interventional Cardiology for Congenital Heart Disease

Kenny

2018

Korean Circ J

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Congenital heart interventions are now replacing surgical palliation and correction in an evolving number of congenital heart defects. Right ventricular outflow tract and ductus arteriosus stenting have demonstrated favorable outcomes compared to surgical systemic to pulmonary artery shunting, and it is likely surgical pulmonary valve replacement will become an uncommon procedure within the next decade, mirroring current practices in the treatment of atrial septal defects. Challenges remain, including the lack of device design focused on smaller infants and the inevitable consequences of somatic growth. Increasing parental and physician expectancy has inevitably lead to higher risk interventions on smaller infants and appreciation of the consequences of these interventions on departmental outcome data needs to be considered. Registry data evaluating congenital heart interventions remain less robust than surgical registries, leading to a lack of insight into the longer-term consequences of our interventions. Increasing collaboration with surgical colleagues has not been met with necessary development of dedicated equipment for hybrid interventions aimed at minimizing the longer-term consequences of scar to the heart. Therefore, great challenges remain to ensure children and adults with congenital heart disease continue to benefit from an exponential growth in minimally invasive interventions and technology. This can only be achieved through a concerted collaborative approach from physicians, industry, academia and regulatory bodies supporting great innovators to continue the philosophy of thinking beyond the limits that has been the foundation of our specialty for the past 50 years.

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Implementation of Methodology for Quality Improvement in Pediatric Cardiac Catheterization: A Multi-center Initiative by the Congenital Cardiac Catheterization Project on Outcomes—Quality Improvement (C3PO-QI)

Cited by 23 publications

References 10 publications

Establishment of a thalassaemia major quality improvement collaborative in Pakistan

Establishment of a thalassaemia major quality improvement collaborative in Pakistan

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

Interventional Cardiology for Congenital Heart Disease

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