Focusing quality pediatric heart care on what can be done better

Norton Children’s Heart Institute is now looking at trends, rather than isolated cases, to improve quality and safety.

Traditionally, quality improvement for surgeons focuses on cases that did not go as planned. These cases are dissected at weekly morbidity and mortality meetings.

A little more than a year ago, Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, completely revamped the classic morbidity and mortality process. We’re looking at trends, rather than isolated cases, and we’re focused on quality improvement, not the worst outcomes.

We’ve also brought more contributors into the process. Critical care, nursing, perfusion and anesthesia have joined surgeons at what we are calling the Norton Children’s Heart Institute Quality and Safety Meeting.

As a heart center, our care for each patient involves skilled teams from various disciplines working in concert. It’s much bigger than a surgeon in the operating room. We need to make sure that everyone at Norton Children’s Heart Institute has a complete picture of what’s going on and that everyone is focused on every detail of care our patients receive.

As part of the quality improvement process, each team is identifying areas for improvement and is collaborating with other teams on what metrics to track and what benchmarks to pursue.

We’re also taking advantage of national databases. Norton Children’s Heart Institute belongs to the Society of Thoracic Surgeons’ congenital heart database, which tracks hundreds of data points for approximately 120 congenital heart surgery programs. Norton Children’s Heart Institute is also part of the Pediatric Cardiac Critical Care Consortium (PC4). By using these registries, we’re able to see rates for major complications and minor ones — data from across the country on things like postoperative arrhythmias, unplanned re-intubations and pressure ulcers.

The databases also show us which pediatric heart centers are doing the best in these various metrics. If there are pediatric heart centers outperforming us in any aspect of care, our goal is to learn from them and improve until we reach or surpass their level. We have several projects in the works where we have reached out to other centers, and we will continue to find areas where we can improve.

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To refer a patient to Norton Children’s Heart Institute, visit Norton EpicLink and choose EpicLink referral to “Pediatric Cardiothoracic Surgery.”

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Interstage home monitoring programs were developed as a way to closely follow single ventricle patients after they have undergone their first palliative operation. The period prior to their second operation can be a tenuous time, and interstage monitoring helps capture subtle changes that, if not recognized, can lead to worse outcomes.

Under the direction of Edward S. Kim, M.D., pediatric cardiologist, and Ashley Rhinehart, APRN, nurse practitioner, at Norton Children’s Heart Institute, the interstage home monitoring program has continued to grow and evolve.

In the past year, Norton Children’s Heart Institute added innovation to this program. The program now gives parents and caregivers specially equipped iPads that allow the team to monitor data as soon as the family enters it, tracking metrics such as oxygen levels, heart rate and nutritional intake. This allows the team to react quickly when a child’s condition changes — sometimes even before the parents realize something is wrong.

Thanks to the program, we have cut the interstage mortality rate for our patients to close to zero, well below the national average.

Quality improvement never ends. We can always do better. Our ultimate goal is perfection, or as close to it as we can get. The Norton Children’s Heart Institute Quality and Safety Meeting, with the bigger, collaborative team, is moving us in that direction.

Deborah Kozik, D.O., is a pediatric cardiothoracic surgeon at Norton Children’s Heart Institute.


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