Interhospital collaboration may improve surgical outcomes in children
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Outcomes after cardiac surgery improved at children’s hospitals that participated in a quality improvement collaborative, according to a study published in the Journal of the American College of Cardiology.
“It tells the average clinician that if you have an opportunity to get access to data on outcomes to see how your practice or your hospital compares to peers and you then have an opportunity to interact with those peers who are achieving high levels of performance, you can improve as well,” Michael Gaies, MD, executive director of the Pediatric Cardiac Critical Care Consortium and director of quality at the Congenital Heart Center at C.S. Mott Children’s Hospital in Ann Arbor, Michigan, told Healio. “Finding ways to access your outcome data and finding infrastructure in which to compare outcomes with peers is useful no matter what specialty you’re in.”
Researchers analyzed data from 19,600 hospitalizations for CV surgery from 18 hospitals from the Pediatric Cardiac Critical Care Consortium clinical registry. There were also 17 hospitals assessed in this study who did not participate in the collaborative.
The Pediatric Cardiac Critical Care Consortium was formed to collect data on patients with primary cardiac disease who were admitted to the cardiac ICU at hospitals that participated in the collaborative. Collaborative learning, timely reporting of outcomes and transparency between hospitals drive quality improvement in the consortium.
“In this collaborative, it’s fairly easy to gain the benefits from participation,” Gaies said in an interview. “For hospitals, there are costs and resources they must put forth, but there’s an obvious return on investment. Once you’re in a collaborative like [Pediatric Cardiac Critical Care Consortium] … gaining access to insights and improving is very easy. It requires hospitals to be willing to look at their practice and outcomes critically and then be willing to reach out and put in the effort to change.”
The primary exposure for this study was participation in the collaborative for 2 years from hospitals with at least 30 months of data. Outcomes of interest included complications, postoperative mortality and resource utilization.
No improvement was noted during the baseline period. Compared with baseline, there were significant improvements after exposure to the collaborative in in-hospital mortality (2.5% vs. 3.3%; relative reduction [RR] = 24%; P = .001), postoperative ICU mortality (2.1% vs. 2.7%; RR = 22%; P = .001) and major complications (10.1% vs. 11.5%; RR = 12%; P < .001). Improvements were also seen in ventilation duration (61.3 hours vs. 70.6 hours; RR = 13%; P = .01) and ICU length of stay (7.3 days to 7.7 days; RR = 5%; P < .001).
Hospitals that did not participate in the collaborative did not have improvements in complications, mortality or length of hospital stay.
“The next level of inquiry is to determine the key features of high-performing hospitals that differentiate them from others and seeing how then to implement changes at hospitals who don’t share those characteristics,” Gaies told Healio. “This research did not explore those mechanisms. The opportunities for change aren’t going to be the same in every single hospital, so there’s not one solution. I’m pretty convinced of that.” – by Darlene Dobkowski
For more information:
Michael Gaies, MD, can be reached at University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, 1540 E. Hospital Drive, Ann Arbor, MI 48109; email: mgaies@med.umich.edu; Twitter: @mgaies.
Disclosures: Gaies reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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