Sharing and learning through the Pediatric Cardiac Critical Care Consortium: Moving toward precision care

Abstract

Feature Editor's Introduction-The most recent events of the Coronavirus Disease 2019 pandemic have demonstrated that we all live in a small world and we are all inseparably connected to each other. Sharing of medical knowledge has no borders or national identity. The utmost importance of medical collaboration has become increasingly clear. The importance of such collaboration cannot be overemphasized. A timely and topical Invited Expert Opinion article written by one of the leading specialists in Critical Care Medicine, Peter C. Laussen, is published in the current issue of the Journal. Clearly, a Pediatric Cardiac Critical Care Consortium is the type of collaboration that we should all aspire to emulate.

Commentary: In defense of the Hawthorne effect

“…Gaies and colleagues 2 demonstrate improvements in surgical outcomes for programs that participate in the Pediatric Cardiac Critical Care Consortium collaborative. The article by Gaies and colleagues 2 was subsequently reviewed by Peter Laussen 3 who eloquently frames the achievements of the Pediatric Cardiac Critical Care Consortium collaborative within the context of steady evolution in the relationship between observation, data, and performance.…”

“…Laussen 3 outlines a common observation that participation in a collaborative creates Hawthorne-like improvement in performance. It is difficult to pinpoint exactly how participation in a collaborative improves performance.…”

“…Unfortunately, many models include variables that are not modifiable by the caregiving team (eg, genetic syndromes). Laussen 3 outlines the challenging frontier in evaluating programmatic performance, which includes characterization of (currently) unquantifiable clinical factors, including the quality/ process of surgical decision making, the processes included in multidisciplinary care delivery, the ability to predict/prevent/rescue in real time, and the ability of a program to utilize comparative data to improve. These latter (currently) unquantifiable factors are likely to be important characteristics of a program that outperforms others.…”

“…Laussen 3 extends a vision of the future that includes the use of continuous real-time physiologic data to provide instantaneous clinical predictions and recommendations. It is likely that continuing integration of databases across collaborative organizations will eventually coalesce into a linked federated system so that data across platforms will be accessible from a single source to guide clinical care, performance review, and improved risk adjustment capabilities.…”

“…It is likely that continuing integration of databases across collaborative organizations will eventually coalesce into a linked federated system so that data across platforms will be accessible from a single source to guide clinical care, performance review, and improved risk adjustment capabilities. As Laussen notes, 3 the ideal clinical program will be 'self-critical and importantly possess a questioning attitude and culture that can drive change and adapt quickly'. The availability of comparative data will provide fuel for our questioning attitudes and further drive our cultural hunger to improve our performance.…”