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Bates KE, Connelly C, Khadr L, et al. Successful Reduction of Postoperative Chest Tube Duration and Length of Stay After Congenital Heart Surgery: A Multicenter Collaborative Improvement Project. J Am Heart Assoc. 2021;10(21):e020730doi: 10.1161/JAHA.121.020730.
Bates, K. E., Connelly, C., Khadr, L., Graupe, M., Hlavacek, A. M., Morell, E., Pasquali, S. K., Russell, J. L., Schachtner, S. K., Strohacker, C., Tanel, R. E., Ware, A. L., Wooton, S., Madsen, N. L., & Kipps, A. K. (2021). Successful Reduction of Postoperative Chest Tube Duration and Length of Stay After Congenital Heart Surgery: A Multicenter Collaborative Improvement Project. Journal of the American Heart Association, 10(21), e020730. https://doi.org/10.1161/JAHA.121.020730
Bates, Katherine E, et al. "Successful Reduction of Postoperative Chest Tube Duration and Length of Stay After Congenital Heart Surgery: A Multicenter Collaborative Improvement Project." Journal of the American Heart Association vol. 10,21 (2021): e020730. doi: https://doi.org/10.1161/JAHA.121.020730
Bates KE, Connelly C, Khadr L, Graupe M, Hlavacek AM, Morell E, Pasquali SK, Russell JL, Schachtner SK, Strohacker C, Tanel RE, Ware AL, Wooton S, Madsen NL, Kipps AK. Successful Reduction of Postoperative Chest Tube Duration and Length of Stay After Congenital Heart Surgery: A Multicenter Collaborative Improvement Project. J Am Heart Assoc. 2021 Nov 02;10(21):e020730. doi: 10.1161/JAHA.121.020730. Epub 2021 Oct 29. PMID: 34713712.
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J Am Heart Assoc. 2021 Nov 02;10(21):e020730. doi: 10.1161/JAHA.121.020730. Epub 2021 Oct 29.

Successful Reduction of Postoperative Chest Tube Duration and Length of Stay After Congenital Heart Surgery: A Multicenter Collaborative Improvement Project.

Journal of the American Heart Association

Katherine E Bates, Chloe Connelly, Lara Khadr, Margaret Graupe, Anthony M Hlavacek, Evonne Morell, Sara K Pasquali, Jennifer L Russell, Susan K Schachtner, Courtney Strohacker, Ronn E Tanel, Adam L Ware, Sharyl Wooton, Nicolas L Madsen, Alaina K Kipps

Affiliations

  1. Congenital Heart Center University of Michigan C.S. Mott Children's Hospital Ann Arbor MI.
  2. Department of Pediatrics University of Michigan Medical School Ann Arbor MI.
  3. Anderson Center Cincinnati Children's Hospital Medical Center Cincinnati OH.
  4. The Heart Institute Cincinnati Children's Hospital Medical Center Cincinnati OH.
  5. Department of Pediatrics University of Cincinnati School of Medicine Cincinnati OH.
  6. Department of Pediatrics Children's Heart Center Medical University of South Carolina Children's Health Charleston SC.
  7. Department of Pediatrics Heart Institute University of Pittsburgh Medical Center Children's Hospital of Pittsburgh Pittsburgh PA.
  8. Department of Pediatrics Labatt Family Heart Centre The Hospital for Sick Children Toronto Ontario Canada.
  9. Cardiac Center The Children's Hospital of Philadelphia Philadelphia PA.
  10. Department of Pediatrics Perelman School of MedicineUniversity of Pennsylvania Philadelphia PA.
  11. Pediatric Heart Center UCSF Benioff Children's Hospital San Francisco CA.
  12. Department of Pediatrics UCSF School of Medicine San Francisco CA.
  13. Department of Pediatrics The Heart Center Primary Children's Hospital Salt Lake City UT.
  14. Department of Pediatrics Betty Irene Moore Children's Heart CenterLucile Packard Children's Hospital at StanfordStanford School of Medicine Palo Alto CA.

PMID: 34713712 DOI: 10.1161/JAHA.121.020730

Abstract

Background Congenital heart disease practices and outcomes vary significantly across centers, including postoperative chest tube (CT) management, which may impact postoperative length of stay (LOS). We used collaborative learning methods to determine whether centers could adapt and safely implement best practices for CT management, resulting in reduced postoperative CT duration and LOS. Methods and Results Nine pediatric heart centers partnered together through 2 learning networks. Patients undergoing 1 of 9 benchmark congenital heart operations were included. Baseline data were collected from June 2017 to June 2018, and intervention-phase data were collected from July 2018 to December 2019. Collaborative learning methods included review of best practices from a model center, regular data feedback, and quality improvement coaching. Center teams adapted CT removal practices (eg, timing, volume criteria) from the model center to their local resources, practices, and setting. Postoperative CT duration in hours and LOS in days were analyzed using statistical process control methodology. Overall, 2309 patients were included. Patient characteristics did not differ between the study and intervention phases. Statistical process control analysis showed an aggregate 15.6% decrease in geometric mean CT duration (72.6 hours at baseline to 61.3 hours during intervention) and a 9.8% reduction in geometric mean LOS (9.2 days at baseline to 8.3 days during intervention). Adverse events did not increase when comparing the baseline and intervention phases: CT replacement (1.8% versus 2.0%,

Keywords: cardiac surgical procedures; chest tubes; congenital; heart defects; length of stay; postoperative period

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