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Multicenter Study
. 2013 Oct;99(19):1445-50.
doi: 10.1136/heartjnl-2013-303671. Epub 2013 Apr 5.

Real time monitoring of risk-adjusted paediatric cardiac surgery outcomes using variable life-adjusted display: implementation in three UK centres

Christina Pagel  1 , Martin Utley, Sonya Crowe, Thomas Witter, David Anderson, Ray Samson, Andrew McLean, Victoria Banks, Victor Tsang, Katherine Brown
Affiliations
Free PMC article
Multicenter Study

Real time monitoring of risk-adjusted paediatric cardiac surgery outcomes using variable life-adjusted display: implementation in three UK centres

Christina Pagel et al. Heart. 2013 Oct.
Free PMC article

Abstract

Objective: To implement routine in-house monitoring of risk-adjusted 30-day mortality following paediatric cardiac surgery.

Design: Collaborative monitoring software development and implementation in three specialist centres.

Patients and methods: Analyses incorporated 2 years of data routinely audited by the National Institute of Cardiac Outcomes Research (NICOR). Exclusion criteria were patients over 16 or undergoing non-cardiac or only catheter procedures. We applied the partial risk adjustment in surgery (PRAiS) risk model for death within 30 days following surgery and generated variable life-adjusted display (VLAD) charts for each centre. These were shared with each clinical team and feedback was sought.

Results: Participating centres were Great Ormond Street Hospital, Evelina Children's Hospital and The Royal Hospital for Sick Children in Glasgow. Data captured all procedures performed between 1 January 2010 and 31 December 2011. This incorporated 2490 30-day episodes of care, 66 of which were associated with a death within 30 days.The VLAD charts generated for each centre displayed trends in outcomes benchmarked to recent national outcomes. All centres ended the 2-year period within four deaths from what would be expected. The VLAD charts were shared in multidisciplinary meetings and clinical teams reported that they were a useful addition to existing quality assurance initiatives. Each centre is continuing to use the prototype software to monitor their in-house surgical outcomes.

Conclusions: Timely and routine monitoring of risk-adjusted mortality following paediatric cardiac surgery is feasible. Close liaison with hospital data managers as well as clinicians was crucial to the success of the project.

Keywords: CARDIAC SURGERY; CONGENITAL HEART DISEASE.

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Figures

Figure 1
Figure 1
Variable life-adjusted display (VLAD) chart for centre A. Each dot represents a surgical episode.
Figure 2
Figure 2
Variable life-adjusted display (VLAD) chart for centre B. Each dot represents a surgical episode.
Figure 3
Figure 3
Variable life-adjusted display (VLAD) chart for centre C. Each dot represents a surgical episode.
Figure 4
Figure 4
A close-up of a section of the variable life-adjusted display (VLAD) plot for centre B showing some features of VLADs.
Figure 5
Figure 5
The Excel output showing the risk profile of centre B compared to the national average. CCAD, Central Cardic Audit Database.
See this image and copyright information in PMC

References

    1. NHS Safe and Sustainable: Childrens Congenital Cardiac Services. NHS Specialist Services. 2011. http://www.specialisedservices.nhs.uk/safe_sustainable/childrens-congeni... (accessed 3 Jan 2013).
    1. McGauran A. Radcliffe should stop doing children's heart surgery, review recommends. BMJ 2010;341:c5863–3
    1. McGauran A. Fewer hospitals in England should perform children's heart surgery. BMJ 2011;342:d1129–9
    1. Dyer C. Consultation process on closing children's cardiac surgery services at Brompton Hospital was fair, judges rule. BMJ 2012;344:e2896–6 - PubMed
    1. CCAD Central Cardic Audit Database: Paediatric Analysis Home Page. Congenital Heart Disease Website. 2011. http://www.ucl.ac.uk/nicor/ (accessed 29 Jan 2011).

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