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Summary
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Transparency in paediatric cardiac surgery outcomes drives the need for effective teamwork and shared decision-making. Understanding these dynamics is key to balancing quality care, accountability, and collaboration among healthcare professionals.

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Cardiac surgeryanaesthesiacardiologyintensive carenursing

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Area of Science:

  • Paediatric and congenital cardiac surgery
  • Healthcare quality and safety
  • Medical teamwork and collaboration

Background:

  • The high-stakes field of paediatric and congenital cardiac care involves multidisciplinary teams with potential for both collaboration and conflict.
  • Public reporting of surgical outcomes introduces demands for transparency, accountability, and effective teamwork.
  • Disagreements among healthcare providers are common, necessitating strategies for shared decision-making (SDM).

Purpose of the Study:

  • To explore the balance between quality healthcare, transparency, and teamwork in paediatric cardiac surgery.
  • To understand how transparency in outcomes reporting influences the implementation of teamwork and shared decision-making strategies.
  • To present a framework for managing disagreements within multidisciplinary teams to ensure optimal patient care.

Main Methods:

  • Review of the Society of Thoracic Surgeons (STS) public reporting initiatives for paediatric and congenital cardiac surgery outcomes.
  • Analysis of the STS Congenital Heart Surgery Database (STS-CHSD) Mortality Risk Model.
  • Description of a tiered approach to shared decision-making (SDM Levels 1-3) for managing clinical disagreements.

Main Results:

  • Public reporting of outcomes, initiated by the STS in 2015, creates pressure for improved teamwork and shared decision-making.
  • The STS-CHSD Mortality Risk Model provides adjusted operative mortality data.
  • SDM Level 3 decisions, where disagreements are critical, pose the greatest challenge to team cohesion and patient care.

Conclusions:

  • Transparency and public reporting in paediatric cardiac surgery necessitate robust teamwork and shared decision-making.
  • Effective management of disagreements, particularly Level 3 decisions, is crucial for maintaining team unity and delivering excellent patient care.
  • Leaving egos aside and fostering mentorship are vital for achieving optimal outcomes in complex paediatric cardiac care settings.