Single-Center Use of Real-Time Society of Thoracic Surgeons Congenital Heart Surgery Data to Improve Institutional Outcomes.

Abstract

Improving quality of care in pediatric cardiac surgery is complex. We describe using institutional The Society of Thoracic Surgery (STS) Congenital Heart Surgery Database (CHSD) data in real time to develop a quality framework with the aim of optimizing team performance and thus improving clinical outcomes. A single-center retrospective study was undertaken spanning 8 quarters: 3 quarters (Q) preimplementation (Q4 2022, Q1 2023, and Q2 2023), 2 quarters during implementation (Q3 2023 and Q4 2023), and 3 quarters postimplementation (Q1 2024, Q2 2024, and Q3 2024). STS CHSD data are abstracted from medical records, input into third-party software, and are used to create visual plots for each index procedure at weekly rounds called "Collaborative Multidisciplinary Assessment of Performance Rounds" (CMAP) and to create an STS Dashboard. STS CHSD unadjusted data and Pediatric Cardiac Critical Care Consortium (PC⁴) risk-adjusted clinical outcomes were compared preimplementation and postimplementation. CMAP were instituted in Children's Nebraska Criss Heart Center in July 2023. CMAP attendance median is 59 (interquartile range, 48-74). The case mix preimplementation and postimplementation is similar (17.7% The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery [STAT] Congenital Heart Surgery Mortality Categories 4 or 5 cases vs 18%). Postimplementation, 39 CMAP presented 223 index procedures. There were trends to decreased risk-adjusted PC⁴ outcomes postimplementation vs preimplementation, including failure-to-rescue, major complication, cardiac arrest, seizures, infection and unplanned reintervention. CMAP discussions have resulted in "CMAP Takeaways," which have informed quality care initiatives. Our data demonstrate the feasibility and power of using real-time STS CHSD unadjusted data to create a quality framework based on transparent data sharing and psychological safety to enhance team performance in congenital heart surgery.