The application of a simplified system of criterions for audit to improve paediatric cardiologic and paediatric cardiac surgical care: evidence from a regional approach in Hungary.
OBJECTIVE
To evaluate the quality of cardiac and surgical care provided for children with congenital cardiac malformations in the eastern county of Hungary.


METHODS
We used the method of clinical audit based in selection of criterions, developing five such criterions concerning timely diagnosis, access to treatment, and outcome. To examine compliance with these criterions, we analysed retrospectively the routine data relating to children living in Hajdu-Bihar County. The period of observation lasted from January, 1994, until December, 2001, and was divided into two epochs in order to evaluate any changes over time.


RESULTS
In the first epoch, 28 infants, representing 0.1% of all newborns, died of congenital cardiac disease, with one of the malformations being recognised post mortem. In the second epoch, 21 infants died, representing 0.09% of newborns. In this group, each malformation was diagnosed before death. In each period, 6 infants died without having undergone cardiac surgery, and having no other non-cardiac disease. The overall postoperative mortality was 9.2% for the first period, and 4.6% for the second. The number of patients waiting for non-urgent repair had reduced significantly by the end of the second epoch.


CONCLUSIONS
The results show that the timely diagnosis of congenital cardiac malformations is in line with accepted international standards. Conversely, the access to invasive treatment was limited over the period of observation, albeit that the waiting list was reduced significantly by the end of the second epoch. The postoperative mortality for those suffering congenital cardiac malformations is also comparable with international standards, except for mortality during infancy for treatment of complex anomalies. Our audit highlights the need for surgical repair of the more complex malformations during infancy.
Department of Paediatrics, Medical and Health Science Centre, University of Debrecen, Debrecen, Hungary. mogyoros@jaguar.dote.hu
Gabor
G
Mogyorosy
Tunde
T
Karacsonyi
Eva
E
Szucs
Laszlo
L
Kiraly
Tamas
T
Kovacs
Andras
A
Szatmari
D000293:Adolescent; D002309:Cardiology / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D006297:Health Services Accessibility / Q000592:standards; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008485:Medical Audit / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D010372:Pediatrics / Q000592:standards*; D013903:Thoracic Surgery / Q000592:standards*; D016896:Treatment Outcome; D014850:Waiting Lists