TY - JOUR
T1 - Successful reduction of postoperative chest tube duration and length of stay after congenital heart surgery
T2 - A multicenter collaborative improvement project
AU - Bates, Katherine E.
AU - Connelly, Chloe
AU - Khadr, Lara
AU - Graupe, Margaret
AU - Hlavacek, Anthony M.
AU - Morell, Evonne
AU - Pasquali, Sara K.
AU - Russell, Jennifer L.
AU - Schachtner, Susan K.
AU - Strohacker, Courtney
AU - Tanel, Ronn E.
AU - Ware, Adam L.
AU - Wooton, Sharyl
AU - Madsen, Nicolas L.
AU - Kipps, Alaina K.
N1 - Publisher Copyright:
© 2021 The Authors.
PY - 2021/11/2
Y1 - 2021/11/2
N2 - BACKGROUND: Congenital heart disease practices and outcomes vary significantly across centers, including postoperative chest tube (CT) management, which may impact postoperative length of stay (LOS). We used collaborative learning methods to determine whether centers could adapt and safely implement best practices for CT management, resulting in reduced postoperative CT duration and LOS. METHODS AND RESULTS: Nine pediatric heart centers partnered together through 2 learning networks. Patients undergoing 1 of 9 benchmark congenital heart operations were included. Baseline data were collected from June 2017 to June 2018, and intervention-phase data were collected from July 2018 to December 2019. Collaborative learning methods included review of best practices from a model center, regular data feedback, and quality improvement coaching. Center teams adapted CT removal practices (eg, timing, volume criteria) from the model center to their local resources, practices, and setting. Postoperative CT duration in hours and LOS in days were analyzed using statistical process control methodology. Overall, 2309 patients were included. Patient characteristics did not differ between the study and intervention phases. Statistical process control analysis showed an aggregate 15.6% decrease in geometric mean CT duration (72.6 hours at baseline to 61.3 hours during intervention) and a 9.8% reduction in geometric mean LOS (9.2 days at baseline to 8.3 days during intervention). Adverse events did not increase when comparing the baseline and intervention phases: CT replacement (1.8% versus 2.0%, P=0.56) and readmission for pleural effusion (0.4% versus 0.5%, P=0.29). CONCLUSIONS: We successfully lowered postoperative CT duration and observed an associated reduction in LOS across 9 centers using collaborative learning methodology.
AB - BACKGROUND: Congenital heart disease practices and outcomes vary significantly across centers, including postoperative chest tube (CT) management, which may impact postoperative length of stay (LOS). We used collaborative learning methods to determine whether centers could adapt and safely implement best practices for CT management, resulting in reduced postoperative CT duration and LOS. METHODS AND RESULTS: Nine pediatric heart centers partnered together through 2 learning networks. Patients undergoing 1 of 9 benchmark congenital heart operations were included. Baseline data were collected from June 2017 to June 2018, and intervention-phase data were collected from July 2018 to December 2019. Collaborative learning methods included review of best practices from a model center, regular data feedback, and quality improvement coaching. Center teams adapted CT removal practices (eg, timing, volume criteria) from the model center to their local resources, practices, and setting. Postoperative CT duration in hours and LOS in days were analyzed using statistical process control methodology. Overall, 2309 patients were included. Patient characteristics did not differ between the study and intervention phases. Statistical process control analysis showed an aggregate 15.6% decrease in geometric mean CT duration (72.6 hours at baseline to 61.3 hours during intervention) and a 9.8% reduction in geometric mean LOS (9.2 days at baseline to 8.3 days during intervention). Adverse events did not increase when comparing the baseline and intervention phases: CT replacement (1.8% versus 2.0%, P=0.56) and readmission for pleural effusion (0.4% versus 0.5%, P=0.29). CONCLUSIONS: We successfully lowered postoperative CT duration and observed an associated reduction in LOS across 9 centers using collaborative learning methodology.
KW - Cardiac surgical procedures
KW - Chest tubes
KW - Congenital
KW - Heart defects
KW - Length of stay
KW - Postoperative period
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U2 - 10.1161/JAHA.121.020730
DO - 10.1161/JAHA.121.020730
M3 - Article
C2 - 34713712
AN - SCOPUS:85121474969
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 21
M1 - e020730
ER -