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Sustaining and spreading success: expanding a multicentre quality improvement project to reduce postoperative chest tube duration after paediatric CHD

Published online by Cambridge University Press:  25 June 2025

Shreya S. Sheth Open the ORCID record for Shreya S. Sheth [Opens in a new window] ,
Ashlin Tignor ,
Chloe Connelly ,
Nicolas L. Madsen ,
Margaret Graupe ,
Katherine E. Bates ,
Mayte Figueroa ,
Lawrence E. Greiten ,
Stephen A. Hart  and
Megan Jensen
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Shreya S. Sheth*
Affiliation:
Baylor College of Medicine, Department of Pediatrics, Division of Cardiology, Houston, TX, USA
Ashlin Tignor
Affiliation:
Cincinnati Children’s Hospital, Cincinnati, OH, USA
Chloe Connelly
Affiliation:
Cincinnati Children’s Hospital, Cincinnati, OH, USA
Nicolas L. Madsen
Affiliation:
University of Texas Southwestern Medical School, Department of Pediatrics, Division of Cardiology, Dallas, TX, USA
Margaret Graupe
Affiliation:
Cincinnati Children’s Hospital, Cincinnati, OH, USA
Katherine E. Bates
Affiliation:
University of Michigan Medical School, Department of Pediatrics, Division of Pediatric Cardiology, Ann Arbor, MI, USA
Mayte Figueroa
Affiliation:
Washington University in St. Louis School of Medicine, Department of Pediatrics, Division of Cardiology, St. Louis, MO, USA
Lawrence E. Greiten
Affiliation:
University of Arkansas for Medical Sciences, Department of Surgery, Arkansas Children’s Hospital, Little Rock, AR, USA
Stephen A. Hart
Affiliation:
Ohio State University College of Medicine, Department of Pediatrics, Section of Cardiology, Columbus, OH, USA
Megan Jensen
Affiliation:
Children’s Mercy Kansas City, Department of Cardiology. Kansas City, MO, USA
Taylor Morse
Affiliation:
University of Texas Southwestern Medical School, Department of Pediatrics, Dallas, TX, USA
Madalsa Patel
Affiliation:
Cleveland Clinic Children’s Hospital, Department of Pediatrics, Division of Cardiology, Cleveland, OH, USA
Amelia St. John
Affiliation:
Children’s Healthcare of Atlanta, Department of Cardiothoracic Surgery, Atlanta, GA, USA
David Saudek
Affiliation:
Medical College of Wisconsin, Department of Pediatrics, Division of Cardiology, Milwaukee, WI, USA
Alaina K. Kipps
Affiliation:
Stanford School of Medicine, Department of Pediatrics, Palo Alto, CA, USA
*
Corresponding author: Shreya Sheth; Email: shreya.sheth@bcm.edu
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Abstract

Objective:

The Pediatric Acute Care Cardiology Collaborative (PAC3) previously showed decreased postoperative chest tube duration and length of stay in children undergoing 9 Society of Thoracic Surgeons benchmark operations. Here we report how these gains were sustained over time and spread to 8 additional centers within the PAC3 network.

Methods:

Patient data were prospectively collected across baseline and intervention phases at the original 9 centres (Pioneer) and 8 new centres (Spread). The Pioneer baseline phase was 6/2017–6/2018 and Spread was 5/2019–9/2019. The Pioneer intervention phase was 7/2018–7/2021 and Spread 10/2019–7/2021. The primary outcome measure was postoperative chest tube duration in hours, with the aim of 20% overall reduction. Balancing measures included chest tube reinsertion and readmission for pleural effusion. Statistical process control methods and traditional statistics were used to analyse outcomes over time.

Results:

Among 5,042 patients at 17 centres, demographics were comparable. The Pioneer cohort (n = 3,383) sustained a 22.6% reduction in mean chest tube duration (from 91.9 hours to 70.5 hours), while the Spread cohort (n = 1,659) showed a 9.7% reduction (from 73.1 hours to 66.0 hours) in the first 13 months following intervention. Across both cohorts, rates of reinsertion (2.0% versus 2.1%, p = 0.869) and readmission for effusion did not change (0.3% versus 0.5%, p = 0.285).

Conclusions:

This multicenter prospective quality improvement study demonstrated sustained reduction in chest tube duration at 9 centres while successfully spreading improvement to 8 additional centres. This project serves as a model for post-operative multicentre quality improvement across a large cohort of congenital cardiac surgery patients.

Keywords

Congenitalquality improvementperioperative managementchest tubes

Information

Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 7
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Copyright
© The Author(s), 2025. Published by Cambridge University Press

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Footnotes

On behalf of the Pediatric Acute Care Cardiology Collaborative (PAC3).

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