Progress in Pediatric Cardiology RSS feed: Current Issue. Progress in Pediatric Cardiology is an international journal of review presenting information and experienced opinion of importance in the understanding and management of cardiovascular diseases in children. Each issue is prepared by one or more Guest Editors and reviews a single subject, allowing for comprehensive presentations of complex, multifaceted or rapidly changing topics of clinical and investigative interest. Topics of Forthcoming Issues •Proceedings of the First International Conference on Computational Simulation in Congenital Heart Disease ( Guest Editors: Jeffrey A. Feinstein and Alison L. Marsden ) •Results on Second International Conference, Cardiomyopathy in Children ( Guest Editor: Steven E. Lipschultz ) •Future of Pediatric Cardiac Care ( Guest Editor: Steven E. Lipschultz ) •Marfan Syndrome and Loeys-Dietz Syndrome ( Guest Editors: Duke E. Cameron, Luca A. Vricella and Hal Dietz ) Readers interested in being a guest editor or participating in the development of a review for publication should contact the Editor-in-Chief, Gary K. Lofland, MD, Progress in Pediatric Cardiology, The Children's Mercy Hospital, 2401 Gilliam Road, Kansas City, MO 64108, USA; E-mail: glofland@cmh.edu Books and reports of clinical or investigative relevance to pediatric cardiovascular medicine will be reviewed and published. Authors, editors and institutions should send one copy for review to the Editor. Electronic usage: An increasing number of readers access the journal online via ScienceDirect, one of the world's most advanced web delivery systems for scientific, technical and medical information. Average monthly article downloads for this journal: 3,648* * Figure is a monthly average of full-text articles downloaded via ScienceDirect in 2011 http://www.ppc-journal.com/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. All rights reserved. Progress in Pediatric Cardiology1058-9813322December 2011 © 2011 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.ppc-journal.com/article/PIIS1058981311000749/abstract?rss=yesEditorial Board10.1016/S1058-9813(11)00074-9Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-8iihttp://www.ppc-journal.com/article/PIIS1058981311000580/abstract?rss=yesSafe and reliable patient care is an international health system priority. The US Institute of Medicine estimates that 100 patients die each day from iatrogenic causes . The fields of pediatric cardiology and cardiac surgery have grown and developed as quickly as any other field in medicine. Although the fundamental biological substrates contributing to congenital heart disease are far from understood. There are great variations in the complexity of congenital cardiac defects. There are nevertheless well established treatment options for correction and palliation of most defects and the pathophysiology is generally well understood. However, there still is a high rate of preventable a relatively high rate of adverse events (mortality and morbidity). These events may or may not be preventable, but the frequency of events and the relatively focused patient population means that the fields of professionals caring for patients with congenital and pediatric cardiac disease are potential models for investigating resilient systems and for studying human errors and their impact on patient safety across healthcare settings.Outcomes analysis, quality improvement, and patient safety for pediatric and congenital cardiac care: Theory, implementation, and applicationsPaul R. Barach, Jeffrey P. Jacobs, Peter C. Laussen, Steven E. Lipshultz10.1016/j.ppedcard.2011.10.001Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-86567http://www.ppc-journal.com/article/PIIS1058981311000592/abstract?rss=yesWe are in the midst of a revolution in health care and the revolution is around quality and safety. The Institute of Medicine in its report “Crossing the Quality Chasm” included safety as a domain of quality although there are unique aspects of improving the safety of patients. Someone has said that quality is doing the right thing well, and safety, is doing the right thing well without hurting anyone. Over the past twenty five years we have developed the ability to define and measure quality . We have developed knowledge of how to improve care. We still have a lot to learn but we are beginning to understand how to define high quality and safe systems of care and how to create them. Physicians and other health professionals have always been concerned with quality and this concern has led to significant improvement especially over the past half century.The heart of the matter: How do I know what I do works?Paul V. Miles10.1016/j.ppedcard.2011.10.002Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-86970http://www.ppc-journal.com/article/PIIS1058981311000609/abstract?rss=yes“It's tough to make predictions, especially about the future.” Yogi Berra was, of course, correct. Just consider this prediction by Ernest Amory Codman, the Boston surgeon and visionary father of the American healthcare quality movement, who was widely ridiculed by his contemporaries :So I am called eccentric for saying in public that hospitals, if they wish to be sure of improvement:must find out what their results aremust analyze their results…must compare their results with those of other hospitalsmust welcome publicity not only for their successes, but for their errorsSuch opinions will not be eccentric a few years henceClinical data registries and the future of healthcare qualityDavid M. Shahian10.1016/j.ppedcard.2011.10.003Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-87174http://www.ppc-journal.com/article/PIIS1058981311000610/abstract?rss=yesAbstract: This manuscript evaluates how substantial improvement in quality and outcomes can be achieved by attention to intra and interpersonal factors that influence learning, growth, innovation and team function. It is difficult to quantify the improvement in outcome in terms of lives saved, errors prevented, morbidity reduced, but the literature on this topic as well as the experience of numerous providers suggests that it will be real and substantial. The recommendations in this manuscript will help you improve your practice.Improved quality and outcomes through congruent leadership, teamwork and life choicesJamie Dickey Ungerleider, Ross M. Ungerleider10.1016/j.ppedcard.2011.10.004Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-87583http://www.ppc-journal.com/article/PIIS1058981311000622/abstract?rss=yesAbstract: One of the most potentially valuable paradigms for improving safety in surgery is known as human factors. However, the main use of this approach has been largely limited to aviation-style teamwork training. In this paper two case studies are presented that illustrate the complex interactions between team, task and technology in paediatric cardiac surgery. Both illustrate primarily how the technological co-ordination of the perfusion task is shared amongst the three key team members. The first case study presents two approaches to going onto cardio-pulmonary bypass, one of which demonstrates a range of key risks. The second presents the transcripts of a case of mild exsanguinations that was quickly recovered from. This case illustrates both the complexity of error and the importance of task-based communications for error capture and recovery. The discussion argues for a broader approach to teamwork considerations in the OR.Task, team and technology integration in the paediatric cardiac operating roomKen R. Catchpole10.1016/j.ppedcard.2011.10.005Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-88588http://www.ppc-journal.com/article/PIIS1058981311000634/abstract?rss=yesAbstract: Effective teamwork is critical to successful outcomes in pediatric cardiac surgery. Unfortunately, lapses in professional performance and conduct by those who treat pediatric cardiac patients pose threats to quality and safety. One hallmark of a profession is self regulation. Therefore, healthcare leaders need specific means for identifying and addressing those lapses and indicators of unsafe systems or individuals. This article describes an initial “near miss” event involving a pediatric cardiac surgeon. While fictional, the case represents a composite of events involving several pediatric cardiac surgeons who practice at different medical centers throughout the U.S.Research shows that patient complaints are significantly associated with physicians' risk management activity and lawsuits. Research also demonstrates that a small subset of physicians and surgeons in various areas of practice are associated with disproportionate shares of patient complaints. Coded and aggregated patient complaint data therefore offer a metric for identifying and promoting behavior change. Analysis of the distribution of patient complaints associated with 41 pediatric cardiac surgeons is presented as a means for helping leaders show one surgeon how her/his risk status compares with peers'. The paper describes a specific plan and reliable process by which medical group/center colleagues and leaders may: 1) address lapses in professionalism and performance; 2) follow-up to promote professionalism, professional accountability, quality, and a safety culture; and 3) reduce risk.Professionalism in support of pediatric cardio-thoracic surgery: A case of a bright young surgeonJames W. Pichert, James A. Johns, Gerald B. Hickson10.1016/j.ppedcard.2011.10.006Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-88996http://www.ppc-journal.com/article/PIIS1058981311000646/abstract?rss=yesAbstract: Meaningful evaluation of the quality of medical and surgical care must include longitudinal follow-up. Long-term evaluation of the outcomes of patients undergoing cardiothoracic operations is a professional responsibility for all who provide care to these patients. Over the past decade, a substantial body of literature has been published related to the potential transformation of short-term clinical registries into platforms for longitudinal follow-up. This transformation will ultimately result in a higher quality of care for all cardiothoracic surgical patients by facilitating outcomes analysis, quality improvement, and clinical and longitudinal comparative effectiveness research on a national and international level. Several potential strategies will allow longitudinal follow-up to be conducted with clinical registries: (1) Linking with Administrative Data; (2) Linking with National Death Registries, such as the Social Security Death Master File (SSDMF) and the National Death Index (NDI); (3) Linking to other Clinical Registries; and (4) Creating Clinical Longitudinal Follow-up Modules.The purpose of this review article is to summarize the current state of the art of strategies for the longitudinal follow-up of patients with pediatric and congenital cardiac disease.Strategies for longitudinal follow-up of patients with pediatric and congenital cardiac diseaseJeffrey P. Jacobs, David L.S. Morales10.1016/j.ppedcard.2011.10.007Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-897102http://www.ppc-journal.com/article/PIIS1058981311000658/abstract?rss=yesAbstract: The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) was established by the Joint Council on Congenital Heart Disease to dramatically improve the outcomes of care for children with congenital heart disease (CHD) through a national collaborative network of multidisciplinary clinical teams and families, working together to collect longitudinal data, use improvement science methods and conduct research intended to accelerate the development and translation of new knowledge into practice. The initial project selected for this learning network is focused on care processes and outcomes of the initial interstage period for infants with hypoplastic left heart syndrome. A practice-based registry is being used to understand variation in care and outcomes of infants and children with complex CHD. The NPC-QIC has effectively recruited and engaged a large number of U.S. centers caring for infants with complex CHD and provides the infrastructure needed to support the implementation of practice changes across the collaborative that will ultimately improve outcomes in this high-risk group of patients. We describe here the development and early years of NPC-QIC as well as the challenges this collaborative faces moving forward.National pediatric cardiology quality improvement collaborative: Lessons from development and early yearsJeffrey B. Anderson, Srikant B. Iyer, Robert H. Beekman, Kathy J. Jenkins, Thomas S. Klitzner, John D. Kugler, Gerard R. Martin, Steven R. Neish, Geoffrey L. Rosenthal, Carole M. Lannon10.1016/j.ppedcard.2011.10.008Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-8103109http://www.ppc-journal.com/article/PIIS105898131100066X/abstract?rss=yesAbstract: The New York State Department of Health developed a Pediatric Cardiac Surgery Reporting System in 1991 that contains detailed information on demographics, diagnoses, procedures, comorbidities, complications, and discharge information for every pediatric cardiac surgery patient in the state. The Department and the Congenital Cardiac Services Subcommittee of the Department's Cardiac Advisory Committee have used data from this system to assess, assure, and improve quality of care and to generate public reports on an ongoing basis. Two reports (one covering 3years and the other covering 4years) have been published, and a third report, comprising the years 2006–2009, will be released shortly. These reports contain information on patient diagnoses, patient severity groups, and risk-adjusted in-hospital mortality rates for all hospitals that perform pediatric cardiac surgery. The goal of the DOH and the CAC is to improve the quality of cardiac care in NYS. Providing the hospitals and cardiac surgeons in NYS with data about their own outcomes for these procedures allows them to examine the quality of the care they provide and to identify areas that need improvement. These data are fed back to providers on an ongoing basis in addition to in the published reports. The overall results of this program of ongoing review show that significant progress is being made.The volume of surgeries and the number of hospitals where they are performed have both decreased dramatically in the years since NYS first began reporting risk-adjusted outcomes for pediatric cardiac surgery. In 1997, 16 hospitals performed 1749 pediatric cardiac surgeries. By 2009, there were only 10 hospitals performing 1304 surgeries. The average number of surgeries per hospital in 1997 was 109 compared to 139 in 2010. Many factors, including increased use of catheter-based therapies, may have contributed to the overall decline in the number of surgeries. The overall mortality rate for pediatric cardiac surgery dropped from 4.08% in 2002 to 2005 period to a mortality rate of 3.35% in 2006 to 2009 period with no major changes in overall patient risk, although part of this decrease may also be due to improvements in the field in general. A multivariable analysis demonstrated that a dedicated pediatric cardiac ICU proved to be a significant independent predictor of mortality. The methods for assessing patients' risk of in-hospital mortality have changed with each successive report, and this study describes the current method and the risk factors used in the method. The Department's other initiatives for improving quality, including consolidation of services, linking processes and structures of care to outcomes, and other regulatory actions, are also described.Regulatory efforts to assess and improve the quality of pediatric cardiac surgery in New York StateEdward L. Hannan, Kimberly S. Cozzens, Zaza Samadashvili, John N. Morley, Roberta G. Williams, Thomas J. Kulik, Frederick Z. Bierman, Carlos E. Ruiz, George M. Alfieris, John J. Lamberti, Jeffrey P. Gold10.1016/j.ppedcard.2011.10.009Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-8111119http://www.ppc-journal.com/article/PIIS1058981311000671/abstract?rss=yesAbstract: Transformations in surgical models of care, including the advent of minimally invasive procedures, bio-robotics and imaging, have revolutionized the cardiovascular physical realm in terms of capability and procedure. An unacceptable number of avoidable patient safety incidents result from the widening disparity between surgical innovation and the environment in which it is applied. Design of cardiovascular operating rooms that aims to minimize the increasing problem of patient safety must consider the behavior of staff and patients as well as the complex interrelationships between culture, technology and achieving reliable, high quality cardiovascular outcomes. There is a need for better, evidence-based physical design guidelines for cardiovascular operating rooms. A better understanding of the relationship between the physical design and its impact on the flow, operations, and culture will positively impact on patient outcomes.Design of cardiovascular operating rooms for tomorrow's technology and clinical practice — Part oneBill Rostenberg, Paul R. Barach10.1016/j.ppedcard.2011.10.010Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-8121128http://www.ppc-journal.com/article/PIIS1058981311000683/abstract?rss=yesAbstract: Expectations of pediatric cardiac surgeons grow as the specialty evolves and yesterday's challenges become tomorrow's routine. The pioneering era of fast-paced major technical advances is behind us. Integration of surgery, cardiology and intensive care is now the basis of incremental improvements in perioperative and long term outcomes. Surgeons can be natural leaders of this process because their skills, roles and experience are crucial in the preoperative, intra-operative and postoperative care of the patient and their family. However, the personality traits that draw physicians to the specialty and contribute to the drive to become a successful technical surgeon may be at odds with the collaborative aspects of this microsystem, both inside and outside the operating room. The potential for disruptive behavior on the part of the surgeon to impede the functioning of a large multidisciplinary team providing care of the upmost complexity raises fundamental questions about how to design reliable pediatric cardiac surgery teams. A new dynamic is needed to support team members, including the surgeon, in times of extreme stress and to help them avoid destructive, maladaptive responses. Focusing these efforts around the clinical microsystem requires a detailed analysis of the team interactions, the underlying culture and support, and the clinical engagement of staff. Building and nurturing a resilient system in a highly specialized environment where burnout, bullying and loss of staff exist remains a constant challenge.Leadership, surgeon well-being and non-technical competencies of pediatric cardiac surgeryDavid S. Winlaw, Matthew M. Large, Jeffrey P. Jacobs, Paul R. Barach10.1016/j.ppedcard.2011.10.011Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-8129133http://www.ppc-journal.com/article/PIIS1058981311000695/abstract?rss=yesAbstract: Clinical handover serves as the basis for transitioning patient care between incoming and outgoing medical providers across shifts and across care settings. Improving handovers of patient care has become an international priority. The handover process offers many opportunities for incidents and adverse patient outcomes. There are several recommendations that guide the work to improve handovers in pediatric cardiac care — approach handover as a complex adaptive process, recognize the effect of culture on creating change and sustaining improvement, develop tools to make information more accessible for clinicians during the handover process, apply human factors principles to the design of handover, focus on training those who are responsible for handovers to effectively handover care, learn from errors and near misses to better understand where failures may occur, actively engage patient families processes of care, and, identify the necessary leadership for creating a learning organization.Improving communication and reliability of patient handovers in pediatric cardiac careJulie K. Johnson, Vineet M. Arora, Emile A. Bacha, Paul R. Barach10.1016/j.ppedcard.2011.10.012Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-8135139http://www.ppc-journal.com/article/PIIS1058981311000701/abstract?rss=yesAbstract: Advances in computer technology have enabled the evolution from traditionally paper-based medical record systems that are fragmented, with associated difficulties in retrieving critical information, to highly accessible and potentially integrated electronic clinical information systems. Hospitals and clinical environments that have employed electronic information systems until recently have typically done so using department or group-specific systems (i.e., by specialty or clinical practice) offered by separate vendors that are often implemented incrementally. This approach, frequently described as best of breed, has been justified when the individual component systems are deemed the best available options for a given application, even if multiple vendor systems that do not interface are ultimately employed. More recent implementation strategies have involved deployment of single vendor, integrated systems across the entire hospital enterprise. A shift from the best of breed strategy toward the enterprise-wide single vendor application strategy has happened due to cost, medical record fragmentation, strain on the institution's technical and support infrastructure, and the emergence of vendor products designed to serve multiple application needs under a single umbrella. This article builds off our implementation experience at Children's Hospital Boston to describe considerations, including potential benefits and pitfalls, of introducing an enterprise-wide clinical information system in a tertiary care pediatric center.Assessing the introduction of enterprise-wide clinical information systems in pediatric medical centerStephanie Altavilla, Jason M. Thornton, Melvin C. Almodovar10.1016/j.ppedcard.2011.10.013Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-8141145http://www.ppc-journal.com/article/PIIS1058981311000713/abstract?rss=yesAbstract: Quality improvement methods offer an approach, a set of tools, and a powerful way of thinking about how to transform clinical operations to achieve better results for patients and healthcare teams. Quality improvement methods are ideally suited to improve the safety and quality of pediatric cardiac surgery (PCS). We review five quality improvement tools that are relevant for improving PCS: checklists, process maps, Ishikawa diagrams, run charts, and control charts. Checklists have received the most attention and the evidence supports the greater adoption of checklists in surgery as well as other medical specialties. Process mapping or flowcharting is an important quality improvement tool that helps clinicians reflect on their mental models – how they understand their environment. Process maps provide insight into how to improve the process or overcome barriers, by soliciting the activities of the care process from the clinical team, coupled with visual representation of the care process. Ishikawa diagrams, also known as cause and effect diagrams or fishbone diagrams, are a graphical representation of the sources of variation in a process. The run chart is a simple plot of a measurement over time with a line drawn at the median; data displayed on the run chart can be related to patients, organizations, or clinical units. Control charts are similar to run charts in that they both provide data displayed over time, however, control charts provide upper and lower control limits that allow the determination of whether a process is stable. Values outside control limits may be an indicator of special cause variation. Each of these five tools can help facilitate tracking and analysis of single and groups of patient process and outcome data and should be become part of the routine manner in which clinicians and healthcare systems deliver care.Quality improvement methods to study and improve the process and outcomes of pediatric cardiac careJulie K. Johnson, Paul R. Barach10.1016/j.ppedcard.2011.10.014Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-8147153http://www.ppc-journal.com/article/PIIS1058981311000786/abstract?rss=yesFuture Topics and Guest Editors10.1016/S1058-9813(11)00078-6Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-8IIhttp://www.ppc-journal.com/article/PIIS1058981311000798/abstract?rss=yesFuture Meetings10.1016/S1058-9813(11)00079-8Progress in Pediatric Cardiology 32, 2 (2011)2011-12-01Progress in Pediatric Cardiology2011-12-01322S1058-9813(11)X0004-8IIIIII