Brian P Quinn1, Priscila Cevallos1, Aimee Armstrong2, David Balzer3, Howaida El-Said4, Susan Foerster5, Andrew C Glatz6, Andrea Goodman1, Bryan Goldstein7, Michael Hainstock8, Dana Janssen9, Jacqueline Kreutzer10, Larry Latson, Ryan Leahy11, Christopher Petit12, Shabana Shahanavaz3, Sara Trucco10, Wendy Whiteside13, Jeffrey D Zampi13, Lisa Bergersen1. 1. Department of Cardiology, Boston Children's Hospital, MA (B.P.Q., P.C., A.G., L.B.). 2. The Heart Center, Nationwide Children's Hospital, Columbus, OH (A.A.). 3. Division of Pediatric Cardiology, St. Louis Children's Hospital, St. Louis, MO (D.B., S.S.). 4. Division of Cardiology, Rady Children's Hospital, San Diego, CA (H.E.-s). 5. Division of Cardiology, Children's Hospital of Wisconsin, Milwaukee (S.F.). 6. Division of Cardiology, Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (A.C.G.). 7. The Heart Institute, Cincinnati Children's Hospital and Department of Pediatrics, University of Cincinnati College of Medicine, OH (B.G.). 8. Division of Pediatric Cardiology, University of Virginia Children's Hospital, University of Virginia, Charlottesville (M.H.). 9. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Nashville, TN (D.J.). 10. Division of Cardiology, Children's Hospital of Pittsburgh of UPMC, PA (J.K., S.T.). The Heart Institute, Joe DiMaggio Children's Hospital and Memorial Healthcare System, Hollywood, FL. 11. The Heart Institute, Children's Hospital of Colorado, Denver (R.L.). 12. Division of Pediatric Cardiology, Children's Healthcare of Atlanta Sibley Heart Center, Atlanta, GA (C.P.). 13. Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor (W.W., J.D.Z.).
Abstract
BACKGROUND: The C3PO-QI (Congenital Cardiac Catheterization Project on Outcomes - Quality Improvement), a multicenter registry launched in 2015, instituted quality improvement (QI) initiatives to reduce patient radiation exposure. Through regular collaboration, this initiative would allow for harmony among active participants, maximizing efforts and efficiency at achieving radiation best practices. This study sought to report these efforts with a detailed methodology for which institutions can target initiatives, reducing radiation exposure, and increasing patient safety. METHODS: Data were collected prospectively by 8 C3PO-QI institutions between January 1, 2015 and December 31, 2017. Radiation exposure was measured in dose area product per body weight (dose area product/kg; µGy*m2/kg) and reported by expected radiation exposure categories (REC) and institution for 40 published unique procedure types. Targeted interventions addressing selected strategic domains for radiation reduction were implemented in the pediatric catheterization labs of the C3PO-QI institutions. RESULTS: The study consisted of 15 257 unique cases. Median exposure (dose area product/kg) was decreased by 30% for all procedures. Dose area product/kg was reduced in all 3 REC, with the greatest improvement observed in REC I (REC I, -37%; REC II, -23%; REC III, -27%). Although the baseline radiation exposures and exact percent decrease varied across all C3PO-QI sites, each institution demonstrated improvements in radiation dose over time. These improvements occurred with the implementation of institution-specific QI interventions accelerated by participation in the C3PO-QI multicenter collaborative. CONCLUSIONS: Substantial radiation dose reductions can be achieved using targeted QI methodology and interventions. Participation in a multicenter QI collaborative may accelerate improvement across all centers due to enhanced engagement and shared learning between sites.
BACKGROUND: The C3PO-QI (Congenital Cardiac Catheterization Project on Outcomes - Quality Improvement), a multicenter registry launched in 2015, instituted quality improvement (QI) initiatives to reduce patient radiation exposure. Through regular collaboration, this initiative would allow for harmony among active participants, maximizing efforts and efficiency at achieving radiation best practices. This study sought to report these efforts with a detailed methodology for which institutions can target initiatives, reducing radiation exposure, and increasing patient safety. METHODS: Data were collected prospectively by 8 C3PO-QI institutions between January 1, 2015 and December 31, 2017. Radiation exposure was measured in dose area product per body weight (dose area product/kg; µGy*m2/kg) and reported by expected radiation exposure categories (REC) and institution for 40 published unique procedure types. Targeted interventions addressing selected strategic domains for radiation reduction were implemented in the pediatric catheterization labs of the C3PO-QI institutions. RESULTS: The study consisted of 15 257 unique cases. Median exposure (dose area product/kg) was decreased by 30% for all procedures. Dose area product/kg was reduced in all 3 REC, with the greatest improvement observed in REC I (REC I, -37%; REC II, -23%; REC III, -27%). Although the baseline radiation exposures and exact percent decrease varied across all C3PO-QI sites, each institution demonstrated improvements in radiation dose over time. These improvements occurred with the implementation of institution-specific QI interventions accelerated by participation in the C3PO-QI multicenter collaborative. CONCLUSIONS: Substantial radiation dose reductions can be achieved using targeted QI methodology and interventions. Participation in a multicenter QI collaborative may accelerate improvement across all centers due to enhanced engagement and shared learning between sites.
Authors: Mary J Yeh; Lauren Shirley; David T Balzer; Brian A Boe; Howaida El-Said; Susan Foerster; Kimberlee Gauvreau; Todd M Gudausky; Michael R Hainstock; Nicola Maschietto; George T Nicholson; Brian P Quinn; Shabana Shahanavaz; Sara Trucco; Wendy Whiteside; Lisa Bergersen Journal: Pediatr Cardiol Date: 2021-11-07 Impact factor: 1.655