Details

Autor(en) / Beteiligte

• Bates, Katherine E
• Madsen, Nicolas L
• Khadr, Lara
• Graupe, Margaret
• Hlavacek, Anthony M
• Morell, Evonne
• Pasquali, Sara K
• Russell, Jennifer L
• Schachtner, Susan K
• Tanel, Ronn E
• Ware, Adam L
• Wooton, Sharyl
• Kipps, Alaina K

Titel

Abstract 11376: Successful Reduction of Postoperative Chest Tube Duration and Length of Stay After Congenital Heart Surgery: A Multicenter Pediatric Acute Care Cardiology Collaborative (pac3) and Pediatric Cardiac Critical Care Consortium (pc4) Improvement Project

Ist Teil von

• Circulation (New York, N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A11376-A11376

Ort / Verlag

by the American College of Cardiology Foundation and the American Heart Association, Inc

Erscheinungsjahr

2019

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• IntroductionWe previously found variation across congenital heart centers in postoperative chest tube (CT) management including one “model” center with shorter CT duration and length of stay (LOS). It was unknown whether the model center’s approach of removing CTs earlier with higher volumes of output could be spread to other centers to reduce variation in CT management and improve outcomes. Using collaborative learning, we conducted a multicenter quality improvement (QI) project to decrease postoperative CT duration and LOS.MethodsPAC and PC data were collected on patients undergoing the 10 STS benchmark operations during the baseline phase (6/2017-6/2018) and intervention phase (7/2018-3/2019). Collaborative learning methods included review of best practices from the model site, regular data feedback on practices and outcomes, monthly webinars, and QI coaching, with an overall goal to reduce CT duration by 20%. Sites adapted CT removal practices (e.g. timing, volume criteria) from the model site to their local resources, practices, and setting. Statistical process control and traditional statistics were used to evaluate CT duration and LOS over time.ResultsOverall 1767 patients from 9 centers were included. Patient characteristics did not differ between eras. Median CT duration decreased from 88.8 [IQR 48.1, 138.5] to 68.9 [IQR 44.5, 114.0] hours (p<0.0001). Median postoperative LOS decreased from 8 [IQR 5,14] to 7 [IQR 5, 11.5] days (p=0.0001). SPC analysis showed a decrease in CT duration and LOS in conjunction with the intervention phase, reported as mean per SPC standards (Figure). Rates of CT replacement (1.9% vs 2.1%, p = 0.40) and readmission for effusion did not change (1.2% vs 1.2%, p = 0.79).ConclusionsWe successfully lowered postoperative CT duration and LOS across 9 centers using collaborative learning methodology. We plan to spread this project to other PAC-PC centers and will monitor for sustained improvement.