Cardiovascular Program

Outcomes

These six areas for measuring quality of care were developed by the Institute of Medicine and are widely used by health care organizations. If you have a question about Children's data, we encourage you to speak to your physician. We are happy to talk to you about program outcomes and the prognosis for your child.

Safe 

Interpretation: Children's average Central Line Associated Bloodstream Infections (CLABSI) rate was higher than the national average reported for other pediatric cardiovascular units recently. A focused response is being conducted in this unit to address the increase and drive improvement. Our ultimate goal is to have zero CLABSIs.

What are we doing to improve: Children's has implemented central line "bundles" which are a set of best practices used to prevent infections when inserting and maintaining lines. We monitor adherence to the bundles and provide ongoing education to staff.

Data source: Children's Infection Prevention and Control Surveillance Data

Benchmark data: "National Healthcare Safety Network (NHSN) Report, Data Summary for 2009, Device-associated Module". Published by the Association for Professionals in Infection Control and Epidemiology, Inc. (Am J Infect Control 2009;37:783-805)

Timing 

This measure still in process.

Efficient 

Interpretation: The length-of-stay ratio compares how long a patient stays in the hospital (actual) to how long they are predicted to stay given the severity of their illness. A ratio of < 1.0 means a patient’s stay was less than expected. Children's performs better than its peers.

What we are doing to improve: Improved discharge planning is the focus of an ongoing quality improvement project.

Data source: Pediatric Health Information System database sponsored by Child Health Corporation of America.

Benchmark data: Average of 43 other children's hospitals. The other children's hospitals ratio can be greater than 1.0 because the expected length of stay comes from a larger, national database. 

Effective

Interpretation: Hospital mortality is the percentage of patients who died during their hospitalization for heart surgery (excluding PDA ligations on patients weighing less than 2500 grams). This rate is not adjusted for severity of illness. Children’s mortality rate compares favorably to the national average.

What are we doing to improve: We conduct a monthly review of surgical cases to discuss ways to improve patient outcomes. Children’s opened a new Cardiovascular Care Center in April 2010. This consolidates all care for heart patients to one floor. We have implemented a new model of care staffing the unit 24/7 with in-house cardiac intensive care physicians. Standardized treatment protocols have also been developed to improve patient care.

Data source: Society of Thoracic Surgeons Congenital Heart Surgery Database - http://www.sts.org/, Table 5 from Spring Harvest 2011.

Benchmark data: 96 hospitals (85 in US, 1 in Canada).

Interpretation: Hospital mortality is the percentage of patients who died during their hospitalization for heart surgery (excluding PDA ligations on patients weighing less than 2500 grams). High-volume hospitals do more than 250 cardiac surgeries per year and have a more reliable estimate of performance than low volume centers where numbers are subject to random variation. These are the most complex and highest risk patients.

Children’s has one of the best survival to discharge rates for high-risk* heart surgeries when compared to high-volume hospitals. Our hospital had 1 deaths out of 59 patients.

*These surgeries are classified by RACHS-1 (Risk Adjustment for Congenital Heart Surgery). RACHS-1 has levels 1-6 in order of increasing complexity and risk. High-risk surgeries include RACHS-1 levels 5-6: Norwood procedure or Damus-Kaye-Stansel procedure for single ventricle palliation, and repair of Ebstein’s anomaly in patients less than 30 days old.

What are we doing to improve: We conduct a monthly review of surgical cases to discuss ways to improve patient outcomes. Children’s has developed a home monitoring program for patients with hypoplastic left heart syndrome, which has been shown to improve survival to their next operation. Children’s Neurodevelopmental Clinic has also developed a follow-up program for patients with congenital heart disease to evaluate and improve long-term outcomes.

Data source: Society of Thoracic Surgeons Congenital Heart Surgery Database - http://www.sts.org/, Table 7 from Spring Harvest 2011.

Benchmark data: 42 hospitals.

Patient-family centered 

Willing to recommend 

 

Interpretation: Most families would definitely recommend Children's to a friend or family member for care. Seven percent of families said they would not recommend Children's in the latest time period. We are currently above our goal of 90%.

What are we doing to improve: We use feedback from our Family Advisory Council and family surveys to improve family experiences.

Data source: NRC Picker Family Survey

BENCHMARK DATA: Not available.

Care and compassion 

Interpretation: Most families said staff definitely showed care and compassion. Twenty percent of families said staff somewhat showed care and compassion, and no families said staff did not show care and compassion in the latest time period. We are currently below our goal of 90%.

What are we doing to improve: All patient care areas are working on ways to continuously improve expressions of care and compassion, including implementation of family centered rounds, family liaisons for all units, and interpreter services on daily rounds.

Data source: NRC Picker Family Survey

Benchmark data: Not available.

Equitable 

This measure is still in process.