Proactive risk mitigation for cardiac arrest prevention in high-risk patients with congenital heart diseaseCentral MessagePerspective
Objective: The prevalence of postoperative cardiac arrest (CA) increases with cardiothoracic surgical case complexity and is associated with a 40% to 50% mortality. Despite having a low overall surgical mortality rate at our center, our postoperative CA rates were higher than expected, with an obser...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273622003746 |
| _version_ | 1797860343813242880 |
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| author | Tara C. Cosgrove, MD, MBOE Jennifer Gauntt, MD Sergio A. Carrillo, MD Steven C. Cassidy, MD Robert J. Gajarski, MD, MHSA Mark Galantowicz, MD Catherine D. Krawczeski, MD |
| author_facet | Tara C. Cosgrove, MD, MBOE Jennifer Gauntt, MD Sergio A. Carrillo, MD Steven C. Cassidy, MD Robert J. Gajarski, MD, MHSA Mark Galantowicz, MD Catherine D. Krawczeski, MD |
| author_sort | Tara C. Cosgrove, MD, MBOE |
| collection | DOAJ |
| description | Objective: The prevalence of postoperative cardiac arrest (CA) increases with cardiothoracic surgical case complexity and is associated with a 40% to 50% mortality. Despite having a low overall surgical mortality rate at our center, our postoperative CA rates were higher than expected, with an observed-to-expected ratio of 2.6. Utilizing quality improvement methodology, we evaluated the influence of proactive risk mitigation on postprocedure CA in a high-risk cohort of pediatric cardiac patients. Methods: This single-center study utilized the Institute for Healthcare Improvement model. We created and implemented our Proactive Mitigation to Decrease Serious Adverse Events program in July 2020, prospectively enrolling preidentified high-risk patients. Enrolled patients underwent scheduled multidisciplinary reviews via virtual platform at 2 periprocedural time points with discussion of patient-specific risks and the subsequent development of proactive risk mitigation plans. Primary outcome measures were derived from the Pediatric Cardiac Critical Care Consortium national registry and included rate of postprocedure CA within 7 days and an institution-specific observed-to-expected ratio for postoperative CA. Results: Our baseline median number of high-risk cases between postprocedure CAs was 3. Following project initiation, median high-risk cases between events increased to 7. Our observed-to-expected ratio for postoperative CA decreased from 2.56 during the 12 months before Proactive Mitigation to Decrease Serious Adverse Events program implementation to 1.01 during the 12 months after Proactive Mitigation to Decrease Serious Adverse Events program implementation, and hospital length of stay decreased by ∼10 days. Conclusions: Implementation of periprocedure-related proactive risk mitigation strategies in high-risk pediatric cardiac patients led to improvement in postprocedure CA with a 133% increase in high-risk cases between events. |
| first_indexed | 2024-04-09T21:44:21Z |
| format | Article |
| id | doaj.art-4e92d87c9f3b4b44a50e0f09024cb495 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-04-09T21:44:21Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-4e92d87c9f3b4b44a50e0f09024cb4952023-03-25T05:15:24ZengElsevierJTCVS Open2666-27362023-03-0113307319Proactive risk mitigation for cardiac arrest prevention in high-risk patients with congenital heart diseaseCentral MessagePerspectiveTara C. Cosgrove, MD, MBOE0Jennifer Gauntt, MD1Sergio A. Carrillo, MD2Steven C. Cassidy, MD3Robert J. Gajarski, MD, MHSA4Mark Galantowicz, MD5Catherine D. Krawczeski, MD6Address for reprints: Tara C. Cosgrove, MD, Division of Pediatric Cardiology, The Heart Center and Center for Clinical Excellence, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH 43205.; Division of Pediatric Cardiology, The Heart Center and Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, OhioDivision of Pediatric Cardiology, The Heart Center and Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, OhioDivision of Pediatric Cardiology, The Heart Center and Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, OhioDivision of Pediatric Cardiology, The Heart Center and Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, OhioDivision of Pediatric Cardiology, The Heart Center and Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, OhioDivision of Pediatric Cardiology, The Heart Center and Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, OhioDivision of Pediatric Cardiology, The Heart Center and Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, OhioObjective: The prevalence of postoperative cardiac arrest (CA) increases with cardiothoracic surgical case complexity and is associated with a 40% to 50% mortality. Despite having a low overall surgical mortality rate at our center, our postoperative CA rates were higher than expected, with an observed-to-expected ratio of 2.6. Utilizing quality improvement methodology, we evaluated the influence of proactive risk mitigation on postprocedure CA in a high-risk cohort of pediatric cardiac patients. Methods: This single-center study utilized the Institute for Healthcare Improvement model. We created and implemented our Proactive Mitigation to Decrease Serious Adverse Events program in July 2020, prospectively enrolling preidentified high-risk patients. Enrolled patients underwent scheduled multidisciplinary reviews via virtual platform at 2 periprocedural time points with discussion of patient-specific risks and the subsequent development of proactive risk mitigation plans. Primary outcome measures were derived from the Pediatric Cardiac Critical Care Consortium national registry and included rate of postprocedure CA within 7 days and an institution-specific observed-to-expected ratio for postoperative CA. Results: Our baseline median number of high-risk cases between postprocedure CAs was 3. Following project initiation, median high-risk cases between events increased to 7. Our observed-to-expected ratio for postoperative CA decreased from 2.56 during the 12 months before Proactive Mitigation to Decrease Serious Adverse Events program implementation to 1.01 during the 12 months after Proactive Mitigation to Decrease Serious Adverse Events program implementation, and hospital length of stay decreased by ∼10 days. Conclusions: Implementation of periprocedure-related proactive risk mitigation strategies in high-risk pediatric cardiac patients led to improvement in postprocedure CA with a 133% increase in high-risk cases between events.http://www.sciencedirect.com/science/article/pii/S2666273622003746cardiac arrest preventionsafety IIproactive safetyrisk mitigationquality improvementcongenital heart disease |
| spellingShingle | Tara C. Cosgrove, MD, MBOE Jennifer Gauntt, MD Sergio A. Carrillo, MD Steven C. Cassidy, MD Robert J. Gajarski, MD, MHSA Mark Galantowicz, MD Catherine D. Krawczeski, MD Proactive risk mitigation for cardiac arrest prevention in high-risk patients with congenital heart diseaseCentral MessagePerspective JTCVS Open cardiac arrest prevention safety II proactive safety risk mitigation quality improvement congenital heart disease |
| title | Proactive risk mitigation for cardiac arrest prevention in high-risk patients with congenital heart diseaseCentral MessagePerspective |
| title_full | Proactive risk mitigation for cardiac arrest prevention in high-risk patients with congenital heart diseaseCentral MessagePerspective |
| title_fullStr | Proactive risk mitigation for cardiac arrest prevention in high-risk patients with congenital heart diseaseCentral MessagePerspective |
| title_full_unstemmed | Proactive risk mitigation for cardiac arrest prevention in high-risk patients with congenital heart diseaseCentral MessagePerspective |
| title_short | Proactive risk mitigation for cardiac arrest prevention in high-risk patients with congenital heart diseaseCentral MessagePerspective |
| title_sort | proactive risk mitigation for cardiac arrest prevention in high risk patients with congenital heart diseasecentral messageperspective |
| topic | cardiac arrest prevention safety II proactive safety risk mitigation quality improvement congenital heart disease |
| url | http://www.sciencedirect.com/science/article/pii/S2666273622003746 |
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