Sustaining and spreading success: expanding a multicentre quality improvement project to reduce postoperative chest
Shreya S Sheth1, Ashlin Tignor2, Chloe Connelly2
1Baylor College of Medicine, Department of Pediatrics, Division of Cardiology, Houston, TX, USA.
Insights
The Pediatric Acute Care Cardiology Collaborative (PAC3) sustained reduced chest tube duration in pediatric cardiac surgery patients. This quality improvement initiative successfully spread to new centers, demonstrating lasting benefits.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery Quality Improvement
- Thoracic Surgery Outcomes
Background:
- The Pediatric Acute Care Cardiology Collaborative (PAC3) previously demonstrated reduced chest tube duration and length of stay.
- Sustaining these improvements and expanding them to new centers is crucial for widespread impact.
Purpose of the Study:
- To report the sustained reduction in postoperative chest tube duration over time.
- To evaluate the successful spread of quality improvement gains to 8 additional centers within the PAC3 network.
Main Methods:
- Prospective data collection across baseline and intervention phases at 17 centers (9 Pioneer, 8 Spread).
- Primary outcome: postoperative chest tube duration (hours); Aim: 20% reduction.
- Balancing measures: chest tube reinsertion, readmission for pleural effusion; Analysis: statistical process control and traditional statistics.
Main Results:
- Among 5,042 patients, the Pioneer cohort (n=3,383) sustained a 22.6% reduction in chest tube duration (91.9 to 70.5 hours).
- The Spread cohort (n=1,659) achieved a 9.7% reduction in the first 13 months (73.1 to 66.0 hours).
- Rates of reinsertion (2.0% vs 2.1%) and readmission for effusion (0.3% vs 0.5%) remained unchanged.
Conclusions:
- This multicenter study demonstrated sustained reduction in chest tube duration at 9 centers.
- Quality improvement gains were successfully spread to 8 additional centers.
- The project serves as a model for multicenter quality improvement in congenital cardiac surgery.
Objective:
The Pediatric Acute Care Cardiology Collaborative (PAC3) previously showed decreased postoperative chest tube duration and length of stay in children undergoing 9 Society of Thoracic Surgeons benchmark operations. Here we report how these gains were sustained over time and spread to 8 additional centers within the PAC3 network.
Methods:
Patient data were prospectively collected across baseline and intervention phases at the original 9 centres (Pioneer) and 8 new centres (Spread). The Pioneer baseline phase was 6/2017-6/2018 and Spread was 5/2019-9/2019. The Pioneer intervention phase was 7/2018-7/2021 and Spread 10/2019-7/2021. The primary outcome measure was postoperative chest tube duration in hours, with the aim of 20% overall reduction. Balancing measures included chest tube reinsertion and readmission for pleural effusion. Statistical process control methods and traditional statistics were used to analyse outcomes over time.
Results:
Among 5,042 patients at 17 centres, demographics were comparable. The Pioneer cohort (n = 3,383) sustained a 22.6% reduction in mean chest tube duration (from 91.9 hours to 70.5 hours), while the Spread cohort (n = 1,659) showed a 9.7% reduction (from 73.1 hours to 66.0 hours) in the first 13 months following intervention. Across both cohorts, rates of reinsertion (2.0% versus 2.1%, p = 0.869) and readmission for effusion did not change (0.3% versus 0.5%, p = 0.285).
Conclusions:
This multicenter prospective quality improvement study demonstrated sustained reduction in chest tube duration at 9 centres while successfully spreading improvement to 8 additional centres. This project serves as a model for post-operative multicentre quality improvement across a large cohort of congenital cardiac surgery patients.
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Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...