World Pediatrics Conference
Emory University School of Medicine, Georgia
Title: Practice variance analysis for process improvement in post-operative care of congenital heart surgery
Biography: Eva K Lee
Congenital heart defects (CHDs) are the most common birth defect and occur in around 1% of births. They are the most common cause of infant deaths due to birth defects, and survivors often face health issues into adulthood. This project describes the transformation that can happen when advanced analytics and operations research is applied to improve the outcome of CHD surgeries in a coordinated effort involving multiple pediatric heart hospitals. Working with the Pediatric Heart Network (PHN), we devised a customizable model and decision support framework that combines systems modeling, simulation-optimization decision analytics, clustering, and machine learning within a collaborative learning paradigm to help hospitals pinpoint key factors on practice variation, and design clinical practice guidelines (CPGs) for rapid implementation to improve the outcomes of CHD surgeries. The project involved the implementation of an early extubation CPG (removal of the breathing apparatus) for patients in five large pediatric heart hospitals. The post implementation results in all sites were positive; early extubation rates increased from 12% to 67%, the median duration of postoperative (post-op) intubation decreased from 21.2 hours to 4.5 hours, and the length of stay (LOS) for patients in intensive care units decreased from 68.5 hours to 51.0 hours. Overall, the five hospital sites experienced LOS reductions ranging from 12% to 35%, decreased time to oral feeds (37%), and an earlier discontinuation of IV analgesics (37% to 55% depending on drug type). This CPG has since become routine practice. Earlier resumption of normal feeding and reduction in analgesics lessen risks of medical complications. Fewer analgesics reduce risks of cognitive impairment and impaired brain development in children. And shorter mechanical ventilation time and LOS for patients reduce their exposure to critical care therapies and indwelling devices, which subsequently reduce the risk of hospital-acquired infections. The implementation resulted in cost savings of approximately 27%, amounting to $13,500 per surgical procedure, on average. It reduced clinical care cost by 65%, pharmacy costs by 46%, laboratory costs by 44%, and imaging costs by 32%.