Collaborative quality improvement in the cardiac intensive care unit: development of the Paediatric Cardiac Critical Care Consortium (PC⁴)

Abstract

Despite many advances in recent years for patients with critical paediatric and congenital cardiac disease, significant variation in outcomes remains across hospitals. Collaborative quality improvement has enhanced the quality and value of health care across specialties, partly by determining the reasons for variation and targeting strategies to reduce it. Developing an infrastructure for collaborative quality improvement in paediatric cardiac critical care holds promise for developing benchmarks of quality, to reduce preventable mortality and morbidity, optimise the long-term health of patients with critical congenital cardiovascular disease, and reduce unnecessary resource utilisation in the cardiac intensive care unit environment. The Pediatric Cardiac Critical Care Consortium (PC4) has been modelled after successful collaborative quality improvement initiatives, and is positioned to provide the data platform necessary to realise these objectives. We describe the development of PC4 including the philosophical, organisational, and infrastructural components that will facilitate collaborative quality improvement in paediatric cardiac critical care.

Epidemiology and Outcomes of Cardiac Arrest in Pediatric Cardiac ICUs*

“…The PC 4 dataset provides information across the full spectrum of cardiovascular disease regarding patient characteristics, diagnoses, procedures and outcomes during the entire CICU encounter. We have previously described the components of the PC 4 clinical registry and architecture of the collaborative (11). Briefly, every CICU encounter at each participating hospital is submitted to the database, and over 90% of the variables are mandatory for case submission, thus ensuring complete data collection on all variables necessary for risk-adjusted outcome reporting.…”

Epidemiology of Noninvasive Ventilation in Pediatric Cardiac ICUs*

“…PC4 is a quality improvement collaborative consisting of hospitals from North America who participate voluntarily [9]. Data from all CICU encounters are submitted to the clinical registry; at the time of this data analysis 15 hospitals were submitting cases.…”

“…All data fields are defined according to standardized definitions in a data definitions manual that is available to all participants on the PC4 internal website. The PC4 Data Coordinating Center audits every participating center on a regular schedule using a combined method of blind chart abstraction by auditors and source data verification [9]. Cases cannot be submitted to the registry unless all mandatory data fields are complete, and approximately 90% of fields are required for submission.…”

Trends in Congenital Heart Disease

“…133,134 The concept of quality as a patient-centered, measurable outcome allows quantification of this variability, and although these measures remain elusive in many areas, procedural practices such as catheterization, electrophysiology, and particularly cardiovascular surgery continue to be increasingly well characterized in this regard. Reduction of practice variation has been identified, therefore, as a specific target for several collaborative quality improvement projects, such as the National Pediatric Cardiology -Quality Improvement Collaborative, 135 the Pediatric Cardiac Critical Care Consortium, 134,136 and the PHN Collaborative Learning Project.…”