Abstract 14034: Sustaining and Spreading Success: Longer Term Outcomes and Spread of a Multi-Center Quality Improvement Project to Reduce Post-operative Chest Tube (CT) Duration (on Behalf of the Pediatric Acute Care Cardiology Collaborative and Pediatric Cardiac Critical Care Consortium)

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Titel: Abstract 14034: Sustaining and Spreading Success: Longer Term Outcomes and Spread of a Multi-Center Quality Improvement Project to Reduce Post-operative Chest Tube (CT) Duration (on Behalf of the Pediatric Acute Care Cardiology Collaborative and Pediatric Cardiac Critical Care Consortium)
Beteiligte: Sheth, Shreya S; Kipps, Alaina; Madsen, Nicolas L; Khadr, Lara; Graupe, Margaret; Tignor, Ashlin; FIGUEROA, MAYTE; Greiten, Lawrence; Hart, Stephen; Jensen, Megan; Mauney, Jennifer A; Morse, Taylor; Patel, Madalsa; St John, Amelia; Saudek, David; Bates, Katherine E
Erschienen: Ovid Technologies (Wolters Kluwer Health), 2020
Erschienen in: Circulation
Sprache: Englisch
DOI: 10.1161/circ.142.suppl_3.14034
ISSN: 0009-7322; 1524-4539
Schlagwörter: Physiology (medical) ; Cardiology and Cardiovascular Medicine
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Beschreibung: <jats:p> <jats:bold>Introduction:</jats:bold> Using a collaborative learning model, we previously showed reduced post-operative CT duration and length of stay (LOS) after 10 STS benchmark surgeries. Here we report sustained gains across the original 9 centers (labeled era 1) and spread of the project (era 2) to 9 new centers in the PAC <jats:sup>3</jats:sup> -PC <jats:sup>4</jats:sup> network. </jats:p> <jats:p> <jats:bold>Methods:</jats:bold> Data on patients undergoing surgeries was collected across the two eras. Each era consisted of a baseline phase (era 1: 6/2017-6/2018, era 2: 5/2019-8/2019) and an intervention phase (era 1: 7/2018-3/2020, era 2: 9/2019-3/2020). The primary outcome was post-operative CT duration in hours, with aim of 20% reduction in the intervention vs baseline phases. Balancing measures included rate of reinsertion and readmission for effusion. The collaborative learning model included monthly webinars with peer support, data transparency, and QI education. Statistical process control methods and traditional statistics were used to analyze CT duration and LOS over time. </jats:p> <jats:p> <jats:bold>Results:</jats:bold> Among 3656 patients at 18 centers, demographics were comparable across eras. Era 1 cohort (n=2779) sustained a 23.5% reduction in CT duration (median 88.9 vs 67.9 hours, p=<.0001) and a 12.5% reduction in LOS days (median 8 vs 7, p=0.03). Era 2 cohort (n=877) showed a 6.95% reduction (median 68.3 vs 63.5 hours, p=0.03) in CT duration in the first 7 months of intervention phase. Across both eras, rates of reinsertion (1.77% vs 1.25%, p=0.48) and readmission for effusion did not change (1.26% vs 2.29%, p=1.00). </jats:p> <jats:p> <jats:bold>Conclusions:</jats:bold> In this multicenter prospective interventional cohort study, reductions in CT duration and LOS were sustained in 9 centers following a collaborative learning model, without adverse events. Nine new centers show promising early results, suggesting that this intervention can be spread successfully. With its use of phased spread, peer support, data transparency, and education, this project serves as a model for sustaining and spreading clinical quality improvement. </jats:p> <jats:p> <jats:graphic xmlns:xlink="http://www.w3.org/1999/xlink" orientation="portrait" position="float" xlink:href="g14034.jpg" /> </jats:p>
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