Improvements in heart-surgery outcomes in kids seen with interhospital collaboration

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By Will Boggs MD

NEW YORK (Reuters Health) - Heart-surgery outcomes in kids improved after a group of hospitals joined forces to form the Pediatric Cardiac Critical Care Consortium (PC4), according to a new report.

"This analysis suggests that collaborative quality improvement focused on the cardiac intensive-care unit (ICU) leads to important improvements in outcomes for patients and implies that outcomes are not all about what happens when the patient is in the operating room," said Dr. Michael Gaies of the University Of Michigan Medical School, in Ann Arbor.

"The needle hadn't moved on mortality over the past decade of congenital heart surgery, and there's only so many ways to sew things together, so our experience and these data demonstrate how we can focus on other aspects of perioperative care to improve the lives of patients and families," he told Reuters Health by email.

Dr. Gaies and colleagues formed PC4 with a vision to improve the outcomes of patients with critical cardiovascular disease. In the current analysis, they investigated whether outcomes improved over time within the consortium. In 2013, six hospitals began contributing data, and now more than 50 hospitals participate.

PC4 promotes quality improvement across hospitals through timely reporting of outcome data to participants, transparency between hospitals and collaborative learning, the authors write in the Journal of the American College of Cardiology, online November 25.

Compared with the baseline period, the period after joining PC4 showed a 22% reduction in cardiac ICU postoperative mortality, a 24% reduction in in-hospital mortality, a 12% reduction in major complications, a 5% reduction in cardiac ICU length of stay, and a 13% reduction in duration of postoperative mechanical ventilation. All changes were statistically significant.

Seven of 18 hospitals cut their adjusted postoperative mortality by at least 1% (with none showing an increase to that degree), eight of 18 hospitals reduced their mean cardiac-ICU length of stay by at least 0.5 day (with one hospital showing an increase to that degree), and 10 of 18 hospitals reduced their mean duration of mechanical ventilation by at least 10 hours (with none showing an increase to that degree).

An analysis of 17 non-PC4 hospitals found no evidence of improvement in major complication rate, total postoperative hospital length of stay, or operative mortality during the same years.

"Transparent data sharing between hospitals and clinicians is arguably the most effective method for improving perioperative care, and it behooves hospitals in our field - congenital heart surgery and pediatric cardiac care more generally - to participate in such networks," Dr. Gaies said. "It is also important for other multicenter clinical registries to consider how they approach transparent data sharing among their participants if that is not currently part of their organization."

"This analysis doesn't explicitly identify the mechanism of improvement, so we can't definitively say that improvement by the cardiac ICU teams led to mortality reduction, but the results are certainly suggestive," he said.

"While this study focused on important short-term outcomes for patients, we are committed to understanding how our practice and quality of care impacts patients over their lifespan," Dr. Gaies said. "Future studies will characterize how long-term outcomes - like neurodevelopment - vary across hospitals, and whether we can learn how to improve these outcomes through our infrastructure."

"While aggregate improvement is exciting and meaningful, we still need to determine why some hospitals are not improving, and how we can best help those hospitals improve," he added. "PC4 is developing an internal mechanism to identify and intervene at hospitals where the outcomes are not as good as could be expected. We aim to make care safe everywhere, so that the quality of care a patient and family receives is not dependent on where the child is born."

SOURCE: https://bit.ly/2qJuzSc J Am Coll Cardiol 2019

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