Pediatric Cardiology Quality and Patient Safety

Quality and patient safety in the Heart Institute

It’s an honor to care for your child and your family. Every day, our pediatric cardiology team works diligently to ensure that your child has access to safe and effective treatments in a family-centered environment.

In the Heart Institute at Children’s Hospital Colorado, we routinely track and report important quality and patient safety metrics to ensure that patient families have an inside view into how we perform. We also publicly report and compare our outcomes with other top pediatric heart centers. Transparency with our patients and colleagues is one of the keys to our success as a top pediatric hospital.

As the largest pediatric heart program in the region, we perform more than 500 heart surgeries and nearly 1,000 heart catheterization procedures per year. Our highly specialized pediatric heart surgeons and interventional cardiologists take on the most complex congenital heart defects (CHDs) and achieve some of the best results in the nation.

Why experience and transparency matter

When your child needs heart surgery, you want the best pediatric heart surgeons to treat them. But how do you know who’s the best?

All pediatric heart centers keep track of how many operations they perform and how many patients survive these surgeries – but many centers do not share their statistics with the public.

Here at the Heart Institute, we believe in empowering families by providing statistics on mortality, volumes, hospital-acquired conditions and patient satisfaction scores up front. Providing this information is not only the right thing to do, it pushes our team to get better and better. It also gives families peace of mind.

Children’s Colorado is the only pediatric heart center in Colorado and one of few in the region to share quality metrics and outcomes data.

Our cardiac surgery and transplant outcomes

The most serious heart conditions typically require open heart surgery or a heart transplant. If your child needs surgery, the most important quality and patient safety metrics are called “outcomes.” (Essentially, success rates.)

At Children’s Colorado, our cardiac surgery and heart transplant outcomes are among the best in the country:

See the complete list of our pediatric cardiac surgery outcomes and pediatric heart transplant outcomes.

Cardiac surgery and interventional cardiology volumes

Another important measure of success for a hospital’s cardiology program is volume, which is the number of surgeries or procedures the hospital performs each year. Performing a higher number of procedures (higher volume) means that the team has more experience with these operations. Studies have shown that this experience correlates to better patient outcomes.

Reference the charts below to learn the number of surgeries and minimally invasive catheterizations we’ve performed since 2016.

Cardiac surgery volume

Cardiac surgery volume indicates the number of heart surgeries performed at a hospital. More complex surgeries require surgeons to use cardiopulmonary bypass, a machine that does the work of the heart and lungs while they repair the heart.

Heart surgeries at Children’s Colorado

Our heart surgeons perform more than 500 surgeries per year, making the Heart Institute at Children’s Colorado a high volume center with vast experience treating even the most serious CHDs.

Cardiac catheterization and electrophysiology procedure volume

Thanks to research and innovation, our team can now treat many defects that used to require surgery with a minimally invasive procedure called cardiac catheterization. Our electrophysiology team can also treat many heart rhythm issues (called arrhythmia) in the cardiac catheterization lab. The charts below show our team’s vast experience performing these procedures.

These volumes indicate that our interventional cardiology team has experience treating hundreds of kids, teens and adults with heart disease each year.

As a high volume center, our cardiology team treats a wide variety of congenital defects and pediatric heart conditions. This means that children and teens who come to the Heart Institute for treatment have a team that’s seen and treated their condition before, even if it’s rare.

Quality in cardiac imaging

Our imaging team provides state-of-the-art images that help our providers understand the medical and surgical needs of every patient. Our advanced capabilities include:

• Cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI)
• Echocardiography
• Fetal imaging, including fetal echocardiography
• 3D imaging

We continuously monitor image quality and accuracy. One way we do it: comparing the echocardiography images to what the surgeon sees in the operating room.

Minor discrepancies mean that a minor anomaly, shunt or cardiac mass that would not affect patient care was not detected in imaging. The major discrepancies definition means that a major anomaly, shunt or cardiac mass that would affect patient care was not detected before surgery.

Since 2016, less than 6% of out of all cardiac images taken in the Heart Institute have had minor discrepancies, and less than 0.5% have had major discrepancies. Our imaging team is helping set national standards for quality in pediatric heart imaging.

Hospital-acquired conditions

In the Heart Institute, we also measure and report what are called “hospital-acquired conditions.” These are complications that patients develop during treatment. Many hospital-acquired conditions are preventable, which is why we continuously work to prevent complications.

One of the risks for kids who need heart surgery is a central line-associated bloodstream infection.

What is a central line-associated bloodstream infection (CLABSI)?

When a patient is in the hospital for heart surgery, we place a small plastic tube called a catheter into the blood vessels near the heart. This is called a central line. Central lines are used to:

• Deliver medication
• Deliver nutritional supplements
• Draw blood for blood tests
• Monitor blood pressure

Sometimes, bacteria enter a patient’s central line, which means these bacteria can enter the patient’s bloodstream and make them sick. This is called a central line-associated bloodstream infection, or CLABSI. The longer patients have a central line, the higher the risk of them getting a CLABSI.

Why do we measure CLABSIs?

Our goal is to never have a bloodstream infection. We measure the CLABSI rate to learn how to prevent them in the future. Our goal is to reduce infection rates, reduce potential complications for our patients and ultimately help kids get better faster.

Recent CLABSI rates at the Heart Institute

We measure CLABSIs in both of our inpatient units, the Cardiac Intensive Care Unit (CICU) and the Cardiac Progressive Care Unit (CPCU). Heart programs measure and report CLABSI rates by the number of CLABSIs per 1,000 patient days.

In 2017, we had a very low rate of CLABSI in our CICU and CPCU. In 2018, despite good compliance with our prevention efforts, we noted an increase in our CLABSI rate: 

• In our CICU, CLABSIs went from less than 1 per 1,000 line days to 2.03 per 1,000 line days. This means 8 patients had a CLABSI in 2018 out of a total 3,940 line days. (As of August 2019, this has decreased to 1.8 per 1,000 line days.)
• In our CPCU, CLABSIs increased from 0 per 1,000 line days to 1.17 per 1,000 line days. This means 3 patients had a CLABSI in 2018 out of a total 2,570 line days. (As of August 2019, this has decreased to 0 per 1,000 line days.)

We have increased our monitoring and diligence in preventing infections. As of August 2019, we have had an overall decrease in CLABSI rates in the Heart Institute.

How are we working to reduce CLABSIs?

Our goal is to constantly and consistently improve. We have a number of projects in place to reduce the possibility of an infection, including:

• Using antibiotics before an operation
• Following best practices for inserting and taking care of central lines
• Working with colleagues throughout the nation to develop best practices and learn from each other

Additional heart care quality indicators

Aside from CLABSIs, we continue to improve the safety and quality of care by thoughtfully and persistently monitoring other quality indicators. In addition to requiring quality metrics from each team within the Heart Institute, we perform weekly safety walk-arounds, which help parents and staff have a voice identifying needs and directing quality improvement initiatives.

Additionally:

• In 2018, the rate of skin injury (> stage II injury) in both our CICU and our CPCU was less than 1 per 1,000 patient days. This year we are transitioning this care metric to include stage II skin injury to ensure that we are constantly detecting ways to decrease skin injury.
• We continue to provide excellent nutrition and closely monitor all of our patients' nutritional health to ensure your child consistently receives the best diet. We have protocols in place to ensure safe transition to oral feeds.
• We measure our daily care bundles and report our compliance to our team and hospital leaders weekly. This helps prevent hospital acquired illness. Care bundles are techniques and tasks that have been proven to help prevent hospital-acquired conditions.
• From 2017 to 2018, we successfully decreased the incidence of peripheral intravenous therapy (peripheral IV or PIV) related injuries from 1.71 to 0.99 per 100 line days.

Learn more about preventing hospital-acquired conditions at Children’s Colorado.

Patient experience

In the Heart Institute, our goal is to provide excellent care for both patients and their families. One way we measure this is by recording and reporting patient satisfaction scores.

From Jan. through Sept. 2019, families rated their experience at the Heart Institute a 9 or 10 (on a scale of 0 to 10, with 10 being the highest) as follows:

Additional resources

We’re committed to providing information and resources before, during and after your visit to the Heart Institute. Visit the links below to learn more.

• See a list of important questions to ask your child's cardiac care team from the Pediatric Congenital Heart Association.
• Download a printable copy of our 2018 Heart Institute Annual Outcomes Report (.pdf).
• Get our list of partner organizations, support groups and other resources for heart families.
• Get tools for caring for a child with chronic illness.
• Learn about your role in your child's healthcare.

Contact us

If you have any questions about this information, please don't hesitate to contact us by calling 720-777-6820.