Related Experiment Video
Updated: Nov 24, 2025
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Pediatric/Congenital Cardiac Catheterization Quality: An Analysis of Existing Metrics
Michael L O'Byrne1, Jing Huang2, Ivor Asztalos3
1Division of Cardiology, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Leonard Davis Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Cardiovascular Outcomes, Quality, and Evaluative Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
This study identified limited quality metrics for pediatric cardiac catheterization labs, mainly focused on safety. Current risk adjustment methods lack confidence, highlighting a need for new metric development.
Area of Science:
- Pediatric Cardiology
- Cardiac Catheterization
- Quality Improvement
Background:
- Pediatric/congenital cardiac catheterization laboratory (PCCL) procedures are vital for young cardiac patients.
- Consistent performance measurement is crucial for improving PCCL outcomes.
- A systematic evaluation of current PCCL quality metrics has not been previously conducted.
Purpose of the Study:
- To enumerate and categorize quality metrics relevant to the pediatric/congenital cardiac catheterization laboratory (PCCL).
- To identify gaps in current quality metrics for PCCL programs.
Main Methods:
- A systematic review of peer-reviewed research was conducted.
- Metrics from relevant organizations were reviewed.
- A survey of U.S. PCCL cardiologists was administered.
Main Results:
- Six safety-focused metrics were identified, including adverse events and radiation exposure.
- Only one organization publicly reports PCCL quality metrics.
- Cardiologists favored safety metrics but expressed low confidence in current risk adjustment (67% ineffective).
Conclusions:
- Current quality metrics for PCCL are limited and predominantly safety-oriented.
- There is a significant lack of confidence in existing risk adjustment methodologies.
- Identified knowledge gaps should inform the development of novel quality metrics for PCCL.
Objectives:
The aim of this study was to enumerate and categorize quality metrics relevant to the pediatric/congenital cardiac catheterization laboratory (PCCL).
Background:
Diagnostic and interventional catheterization procedures are an increasingly important part of the care of young patients with cardiac disease. Measurement of the performance of PCCL programs in a stringent and consistent fashion is a crucial step toward improving outcomes. To the best of our knowledge, a systematic evaluation of current quality metrics in PCCL has not been performed previously.
Methods:
Potential metrics were evaluated by: 1) a systematic review of peer-reviewed research; 2) a review of metrics from organizations interested in quality improvement, patient safety, and/or PCCL programs; and 3) a survey of U.S. PCCL cardiologists. Collected metrics were grouped on 2 dimensions: 1) Institute of Medicine domains; and 2) the Donabedian structure/process/outcome framework. Survey responses were dichotomized between favorable and unfavorable responses and then compared within and between categories.
Results:
In the systematic review, 6 metrics were identified (from 9 publications), all focused on safety either as an outcome (adverse events [AEs], mortality, and failure to rescue along with radiation exposure) or as a structure (procedure volume or operator experience). Four organizations measure quality metrics of PCCL programs, of which only 1 publicly reports data. For the survey, 229 cardiologists from 118 hospital programs responded (66% of individuals and 72% of hospital programs). The highest favorable ratings were for safety metrics (p < 0.001), of which major AEs, failure to rescue, and procedure-specific AEs had the highest ratings. Of respondents, 67% stated that current risk adjustment were not effective. Favorability ratings for hospital characteristics, PCCL characteristics, and quality improvement processes were significantly lower than for safety and less consistent within categories.
Conclusions:
There is a limited number of PCCL quality metrics, primarily focused on safety. Confidence in current risk adjustment methodology is low. The knowledge gaps identified should guide future research in the development of new quality metrics.
More Related Videos
Related Concept Videos
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:21Cardiac Catheterization II: Right Heart Catheterization
01:24Cardiac Catheterization III: Left Heart Catheterization
01:26Cardiac Catheterization IV: Nursing Management
01:30Acute Coronary Syndrome III: Diagnostic Studies