Abstract 59: Increasing Participation In Improvement Work Through Heart Center Performance Rounds

Abstract

Excellence in congenital cardiac care requires team resilience, complex decision-making, analysis of errors to adjust practice, and continuous targeted improvement. Medicine has learned from other high reliability organizations, but effective team communication and awareness of improvement opportunities remain challenging. We describe how our Heart Center Performance Rounds (HCPR) meeting addresses these gaps, and provides attention to quality improvement (QI) work, which in turn leads to increased participation and improved clinical outcomes. Our HCPR is a weekly review of one week’s worth of surgical and catheterization cases. Each patient’s course is reviewed against both internal and external benchmarks, such as length of stay (LOS) and markers of clinical progression. Eligibility for multidisciplinary improvement projects is reviewed for each patient. A committee tracks trends in discussion, assessing areas for improvement work and team learning. This committee then organizes methods for follow up and arranges presentation back to the Heart Center (HC) audience. Over the course of 12 months, we tracked LOS data and participation for two multidisciplinary QI projects to assess project participation and outcomes. Projects featured in HCPR included reduction of chest tube duration and awareness of median clinical targets. Patients undergoing specific operations were eligible, but could be excluded at the request of the clinical team. We noted a decrease in exclusion over 12 months, as teams became more aware of eligibility criteria and early results. As participation in these projects improved, both variability and overall length of stay decreased for 2 of 4 studied operations. Updates on outcomes were periodically presented to HC audience. Survey responses and interviews demonstrated increased awareness of projects and their potential for improved care metrics. Our HCPR has promoted knowledge of benchmarks and increased participation in quality improvement projects, leading to improved clinical outcomes. Transparency in data and communication of ongoing work is essential for success. Challenges include dedicated time and resources for spreading and sustaining improvement.