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Quality improvement: prevention of cardiac arrest in children with heart disease on the paediatric intensive care unit.
СтатьяНазвание и аннотация: Перевод в очереди
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Russell Mark James, Jones Alison, Burlton Susan, Morrison Rachael, Ellis David, Jones Tim, Khan Natasha, Krishnan Hari, Botha Phil
Аннотация
BACKGROUND: A comprehensive quality improvement programme sustainably reduced cardiac arrest (CA) in collaborating North American paediatric cardiac intensive care units. This approach has not been replicated outside the collaborating centres, where the principal focus remains on improving the management, rather than prevention, of CA.
METHODS: A CA prevention bundle was implemented in patients with a cardiac diagnosis perceived to be at high risk of CA when admitted to the paediatric intensive care unit (PICU) from August 2023. Risk-adjusted CA rate was monitored through resetting sequential probability ratio test monitoring, including a retrospective baseline pre-launch period of 1 year. Risk adjustment methodologies were compared.
RESULTS: In 1113 patients with a primary cardiac diagnosis admitted to the PICU, the crude CA rate reduced from 6.2% in the pre-intervention period to 4.4% in the 18 months post intervention (relative reduction of 30%). Resetting sequential probability ratio test monitoring showed a 'halving' reset of CA in the cardiac surgical cohort, indicating a high probability of special cause variation in CA incidence following implementation. The UK national mortality prediction algorithm (Partial Risk Adjustment in Surgery) showed reasonable correlation with the risk prediction algorithm for CA derived from North American data.
CONCLUSIONS: In diverse healthcare settings, some cardiac arrests in children with heart disease can be prevented by implementing a comprehensive quality improvement programme. This was only effective in patients admitted after cardiac surgery and further work is needed to ascertain the reasons for a lack of improvement in cardiac medical admissions. Risk adjustment methodology is vital to process monitoring and requires standardisation.
METHODS: A CA prevention bundle was implemented in patients with a cardiac diagnosis perceived to be at high risk of CA when admitted to the paediatric intensive care unit (PICU) from August 2023. Risk-adjusted CA rate was monitored through resetting sequential probability ratio test monitoring, including a retrospective baseline pre-launch period of 1 year. Risk adjustment methodologies were compared.
RESULTS: In 1113 patients with a primary cardiac diagnosis admitted to the PICU, the crude CA rate reduced from 6.2% in the pre-intervention period to 4.4% in the 18 months post intervention (relative reduction of 30%). Resetting sequential probability ratio test monitoring showed a 'halving' reset of CA in the cardiac surgical cohort, indicating a high probability of special cause variation in CA incidence following implementation. The UK national mortality prediction algorithm (Partial Risk Adjustment in Surgery) showed reasonable correlation with the risk prediction algorithm for CA derived from North American data.
CONCLUSIONS: In diverse healthcare settings, some cardiac arrests in children with heart disease can be prevented by implementing a comprehensive quality improvement programme. This was only effective in patients admitted after cardiac surgery and further work is needed to ascertain the reasons for a lack of improvement in cardiac medical admissions. Risk adjustment methodology is vital to process monitoring and requires standardisation.