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

Creator(s)

Shreya s. Sheth
Ashlin Tignor
Chloe Connelly
Nicolas L. Madsen
Margaret Graupe
Katherine E. Bates
Mayte Figueroa
Lawrence E. Greiten
Stephen A. Hart
Megan Jensen, Children's Mercy HospitalFollow
Taylor Morse
Madalsa Patel
Amelia St John
David Saudek
Alaina K. Kipps

Document Type

Article

Publication Date

6-2025

Identifier

DOI: 10.1017/S1047951125001969

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.

Journal Title

Cardiology in the young

Volume

35

Issue

6

First Page

1154

Last Page

1160

PubMed ID

40556264

Keywords

Congenital; chest tubes; perioperative management; quality improvement

Recommended Citation

Sheth SS, Tignor A, Connelly C, et al. Sustaining and spreading success: expanding a multicentre quality improvement project to reduce postoperative chest tube duration after paediatric CHD. Cardiology in the Young. 2025;35(6):1154-1160. doi:10.1017/S1047951125001969