Our Quality Indicators for Heart Surgery:
- Participation in a systematic multi-institutional database (registry) for cardiac surgery
- Evaluate and benchmark results
- Outcome-based quality improvement initiatives
- On-site full-time database manager dedicated to cardiac surgery
- Participation in preoperative multidisciplinary conference involving cardiology, cardiac surgery, anesthesia, and critical care to plan surgical cases
- Multidisciplinary rounds involving cardiology, cardiac surgery, and critical care
- Regularly scheduled peer review quality assurance conference
- Regularly scheduled multidisciplinary educational conference for “Up-To-Date” topics
- Routine intraoperative transesophageal echocardiography (TEE)
- Routine modified ultrafiltration (MUF)
- Routine cerebral oxygen saturation monitoring
- Availability of continuous mixed venous oxygen saturation monitoring
- Availability of institutional pediatric ExtraCorporeal Life Support (ECLS/ECMO) Program
- Strict protocol for preoperative skin cleansing and appropriately timed antibiotic administration
- Selection of body weight appropriate dosage of all medications
- Routine appropriately timed medication regimen to minimize the inflammatory response to surgery and cardiopulmonary bypass
- Defined safety protocol for re-do sternotomy
- Dedicated pediatric cardiac anesthesiologists
- Dedicated pediatric cardiac OR nursing team
- Board-certified PICU physicians in-house 24/7
- Ongoing patient/family satisfaction survey with active feedback to implement positive change
- Electronic communication of case details to the team 1 week prior to case
- Operative briefing and debriefing of the team
- Defined OR to PICU transfer protocol
Society of Thoracic Surgeons Quality Indicators for Congenital Heart Surgery
In January 2007, the Society of Thoracic Surgeons (STS)1 created a task force to develop quality indicators for pediatric and congenital cardiac surgery. Twenty-six quality measures for congenital heart surgery have been developed for National Quality Forum (NQF)2 endorsement.
The quality measures include elements of a heart surgery program’s structure, process and outcomes. Measures focus on six primary operations: ventricular septal defect (VSD), Tetralogy of Fallot (TOF), atrioventricular septal defect (AVSD), arterial switch (AS), Fontan and Norwood.
1 The STS is a not-for-profit organization, whose mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research and advocacy.
2 The NQF is a private, not-for-profit membership organization, whose mission is to improve American health care through endorsement of consensus-based national standards for measurement and public reporting of health care performance data that provide meaningful information about whether care is safe, timely, beneficial, patient-centered, equitable and efficient.