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Proposed Quality Metrics for Congenital Cardiac Anesthesia: A Scoping Review
Morgan L Brown1, Anna Dorste2, Phillip S Adams3
1From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Insights
This study identifies key quality metrics for congenital cardiac anesthesia, aiming to improve patient care and outcomes. It proposes five essential metrics for widespread adoption and benchmarking in clinical practice.
Area of Science:
- Anesthesiology
- Cardiology
- Quality Improvement
Background:
- Congenital cardiac anesthesia presents unique high-risk scenarios for patient morbidity and mortality.
- Quality metrics are crucial for evidence-based care and targeted clinical improvements.
- A comprehensive review of quality metrics specific to congenital cardiac anesthesia was lacking.
Conclusions:
- The proposed five metrics offer a starting point for improving quality and safety in congenital cardiac anesthesia.
- Further development of primary data, outcome linkage, risk stratification, and national data collection is essential for robust benchmarking.
Abstract:
Congenital cardiac anesthesiologists practice in a unique environment with high risk for morbidity and mortality. Quality metrics can be used to focus clinical initiatives on evidence-based care and provide a target for local quality improvement measures. However, there has been no comprehensive review on appropriate quality metrics for congenital cardiac anesthesia to date. Members of the Quality and Safety Committee for the Congenital Cardiac Anesthesia Society proposed 31 possible candidate topics for metrics. Using a scoping review strategy, 3649 abstracts were reviewed with 30 articles meeting final criteria. Of these, 5 candidate metrics were unanimously proposed for local collection and national benchmarking efforts: use of a structured handover in the intensive care unit, use of an infection prevention bundle, use of blood conservation strategies, early extubation of cardiopulmonary bypass cases, and cardiac arrest under the care of a cardiac anesthesiologist. Many metrics were excluded due to a lack of primary data and perceived complexity beyond the scope of cardiac anesthesia practice. There is a need to develop more primary data including linking process measures with outcomes, developing risk-stratification for our patients, and collecting national data for benchmarking purposes.
