Abstract
Introduction: The NPC-QIC was established in 2008 to improve outcomes of hypoplastic left heart syndrome (HLHS) patients during the interstage period using quality improvement to reduce unnecessary practice variation. Our objective was to evaluate early and recent interstage practice variation within the collaborative. Methods: Data from the first 100 patients (6/2008 - 1/2010) representing 18 centers were compared with the most recent 100 patients (1/2014 - 11/2014) from these same centers. Results: Prenatal diagnosis increased from 72% to 82% (p = 0.09). There were no differences in gestational age or weight at Norwood. A composite of any preoperative risk factor (mechanical ventilation, acidosis, renal insufficiency, arrhythmia, NEC, sepsis) occurred more frequently in the early era (58% vs 34%, p <0.01). While mean age at Norwood was similar (8.3 vs 6.6 days, p = 0.2), the standard deviation for this variable was significantly lower in the recent era (10.5 to 6.4 days, p = 0.03). Use of RV-PA conduit increased (69% to 84%, p = 0.02). Rates of complete discharge communication with both the primary care physician (31 to 97%, p < 0.01) and primary cardiologist (44 to 97%, p < 0.01) increased substantially. There was no change in interstage feeding strategies between eras. Use of interstage outpatient surveillance program increased (76% to 99%, p < 0.01) with all participants in the late era monitoring both oxygen saturation and weight. Conclusions: Among NPC-QIC centers contributing patients to both early and recent cohorts, there were significant changes in preoperative risk factors, Norwood surgical strategy, discharge communication, and interstage surveillance. Practice variation in timing of Norwood has been reduced. Further study is required to determine an association between these practice trends and decreased mortality.
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