title: Real time monitoring of risk-adjusted paediatric cardiac surgery outcomes using variable life-adjusted display: implementation in three UK centres.
abstract: OBJECTIVE
  To implement routine in-house monitoring of risk-adjusted 30-day mortality following paediatric cardiac surgery.
  
  
  METHODS
  Collaborative monitoring software development and implementation in three specialist centres.
  
  
  METHODS
  Analyses incorporated 2 years of data routinely audited by the National Institute of Cardiac Outcomes Research (NICOR). Exclusion criteria were patients over 16 or undergoing non-cardiac or only catheter procedures. We applied the partial risk adjustment in surgery (PRAiS) risk model for death within 30 days following surgery and generated variable life-adjusted display (VLAD) charts for each centre. These were shared with each clinical team and feedback was sought.
  
  
  RESULTS
  Participating centres were Great Ormond Street Hospital, Evelina Children's Hospital and The Royal Hospital for Sick Children in Glasgow. Data captured all procedures performed between 1 January 2010 and 31 December 2011. This incorporated 2490 30-day episodes of care, 66 of which were associated with a death within 30 days.The VLAD charts generated for each centre displayed trends in outcomes benchmarked to recent national outcomes. All centres ended the 2-year period within four deaths from what would be expected. The VLAD charts were shared in multidisciplinary meetings and clinical teams reported that they were a useful addition to existing quality assurance initiatives. Each centre is continuing to use the prototype software to monitor their in-house surgical outcomes.
  
  
  CONCLUSIONS
  Timely and routine monitoring of risk-adjusted mortality following paediatric cardiac surgery is feasible. Close liaison with hospital data managers as well as clinicians was crucial to the success of the project.
authors.affiliation: Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK. c.pagel@ucl.ac.uk
authors.forename: Christina
authors.initials: C
authors.lastname: Pagel
authors.forename: Martin
authors.initials: M
authors.lastname: Utley
authors.forename: Sonya
authors.initials: S
authors.lastname: Crowe
authors.forename: Thomas
authors.initials: T
authors.lastname: Witter
authors.forename: David
authors.initials: D
authors.lastname: Anderson
authors.forename: Ray
authors.initials: R
authors.lastname: Samson
authors.forename: Andrew
authors.initials: A
authors.lastname: McLean
authors.forename: Victoria
authors.initials: V
authors.lastname: Banks
authors.forename: Victor
authors.initials: V
authors.lastname: Tsang
authors.forename: Katherine
authors.initials: K
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D005240:Feasibility Studies; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010348:Patient Care Team; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D012985:Software Design; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
keywords: CARDIAC SURGERY; CONGENITAL HEART DISEASE
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