Why “VPS Cardiac” is
Different
Howard Jeffries MD/MBA
Medical Director, Accountable Care - Seattle Children’s Hospital
Jennifer Daufeldt RN
VPS Cardiac Program Coordinator/Quality Analyst
Nomenclature & Procedure Code Origin
• Terms mapped to short list of the International Paediatric and Congenital
Cardiac Code (IPCCC) utilized by the Society of Thoracic Surgeons (STS)
• Detailed and accepted procedural, diagnostic, and complication terms
• Identification of Index Procedure (assignment of case complexity):
• Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1)
• Aristotle Basic Complexity Score
Current VPS Cardiac Units
•
•
•
•
•
•
•
•
•
•
Seattle Children's Hospital
Seattle
WA
Children's Hospital of Wisconsin
Milwaukee
WI
Nationwide Children's Hospital
Columbus
OH
Children's Hospital Los Angeles
Los Angeles
CA
Children's Hospitals and Clinics of Minnesota
Minneapolis
MN
Atlanta
GA
San Francisco
CA
Wilmington
DE
Arnold Palmer Hospital for Children
Orlando
FL
Walt Disney Pavilion at Florida Hospital for Children
Orlando
FL
Children‘s Healthcare of Atlanta – Egleston
UCSF Benioff Children's Hospital
Alfred I. DuPont Hospital for Children
VPS
Current VPS Mixed Units
•
•
•
•
•
VPS Mixed Units are PICUs with a Cardiac Program
Currently 47 VPS Mixed Units Participating in VPS
Option to Participate in Separate Cardiac Reporting
Total of 57 Units Entering Cardiac Data into the Application
Provides Enhanced Levels of Comparison Data Yielding Prosperous Cardiac
Vs. Mixed Unit Outcomes
Cardiac Specific
Comparison
Reports
Table of Contents: The Bonus of Cardiac Reporting
Cardiac Medical Patients
Cardiac Surgical Patient Analysis
Severity of Illness Tools
PRISM
• Predicts Intensive Care Outcomes
• Collection Timeframe is the First 12 hours of
ICU Admission
• Uses the Most Extreme Values Documented
• Variables: Cardiovascular Data, AcidBase/Blood Gas Data, Chemistry Data,
Hematology Test Data, Two Acute
Diagnoses, Two Diagnoses Reflecting Acute
and Chronic Health Status, and Four
Additional Risk Variables
PICSIM
• Cardiac Surgical Mortality Score
• 13 Risk Variables: Includes
Physiologic Status, Cardiovascular
Condition, and Time of Admit to
ICU
• Uses STAT Score
Pediatric Index of Cardiac Surgical
Intensive Care Mortality
PICSIM
Variables Utilized
• Gender
• Weight
• Patient Origin from Operating Room
• Systolic Blood Pressure
• Respiratory Rate
• FiO2
• Temperature
• Status of Mechanical Ventilation
• Status of Elective Admission to ICU
• Operative status
• High risk for Cardiomyopathy or Myocarditis
• High risk for Hypoplastic Left Heart Syndrome
• Blood Urea Nitrogen (BUN)
• Creatinine
• Status of admission from inpatient unit
• Status of Closed or Open chest cardiac massage
Cardiac Advisory
Group
Current Members
2015
•
•
•
•
Dr. Jeremy Affolter……………..Children's Hospital of Wisconsin
•
•
•
•
•
Dr. Sylvia del Castillo…………….Children's Hospital Los Angeles
•
•
•
•
Dr. Erica Molitor-Kirsch…………...The Children’s Mercy Hospital
Dr. Adnan Bhutta……………………….University of Maryland
Dr. Caroline Boyd………….Alfred I. DuPont Hospital for Children
Dr. David Dassenko……………………..Children's Hospitals and
Clinics of Minnesota
Dr. Harun Fakioglu…………..Arnold Palmer Hospital for Children
Dr. Punkaj Gupta…………………...Arkansas Children’s Hospital
Dr. Howard Jeffries…………………... Seattle Children's Hospital
Dr. Paulette Johnson………………Walt Disney Pavilion at Florida
Hospital for Children
Dr. Rebecca Russell………………Children's Hospital of Wisconsin
Dr. Janet Simsic…………………….Nationwide Children's Hospital
Dr. Michael Wolfe……….Children‘s Healthcare of Atlanta - Egleston
VPS Cardiac Advisory Group GOALS
• Improve the Overall Care of Patients in Cardiac ICU’s
• Develop Cardiac ICU Specific Components for the Application
• Advance the VPS Cardiac Database by Continuous Improvements in Data
Fields, Data Elements, and Reporting Functionality
• Identify Areas for Quality Improvement Projects and Research
• Encourage Use for Adoption and Creation of Knew Knowledge
COMPLICATIONS LIST
• Bleeding Requiring
• Post Procedural Arrhythmia Requiring
•
•
•
•
•
Reoperation
Cardiorespiratory Arrest
Chylothorax
New Onset Seizure
Pericardial or Pleural Effusion
Requiring Drainage
• Phrenic Nerve Injury
•
•
•
•
Temporary Pacing or Permanent
Pacemaker
Post Procedural Arrhythmia Requiring
Anti-arrhythmia Medication
Pneumothorax Requiring Tx
Mechanical Assist Device
Vocal Cord Dysfunction
Renal Failure Requiring Dialysis
COMPLICATIONS
LIST
(CONTINUED)
A ROBUST RESEARCH TOOL
• Wide population coverage
• Large number of variables
collected
• High level of data granularity
• Large number of participating
institutions (>127 hospitals)
• Currently the largest database for
cardiac ICU patients (>100,000
patients)
• Standardized Clinical Data Definitions
• Shares many common definitions with STSCHSD (Society of Thoracic Surgeons
Congenital Heart Surgery Database)
• Extensive quality validation prior to data
release
• Inter-rater reliability (IRR) concordance >
95%
• Data extraction: scientific, specific and
consistent
PUBLISHED RESEARCH ARTICLES
Performance of the Pediatric Index of Mortality 2 for pediatric cardiac surgery patients
Angela S. Czaja, MD, MSc; Matthew C. Scanlon, MD; Evelyn M. Kuhn, PhD; Howard E. Jeffries, MD, MPH, MBA
Pediatr Crit Care Med 2011 Vol. 12, No. 2
Vasoactive-Inotropic Score Is Associated With Outcome After Infant Cardiac Surgery: An
Analysis From the Pediatric Cardiac Critical Care Consortium and Virtual PICU System
Registries
Micheal G. Gaies, MD; Howard E. Jeffries, MD; Robert A. Niebler, MD; Sara K. Pasquali, MD; Janet E. Donohue, MPH;
Sunkyung Yu, MS; Christine Gall, MS; Tom B. Rice, MD; Ravi R. Thiagarajan, MD
www.pccmjournal.org July 2014 Volume 15 Number 6
The Relationship Between In-House Attending Coverage and Nighttime Extubation
Following Congenital Heart Surgery
Glen J. Iannucci, MD; Matthew E. Oster, MD, MPH; Nikhil K. Chanani, MD; Scott E. Gillespie, MS; Courtney E.
McCracken, PhD; Kirk R. Kanter, MD; William T. Mahle, MD
www.pccmjournal.org March 2014 Volume 15 Number 3
PUBLISHED RESEARCH ARTICLES
Effect of race on the timing of the Glenn and Fontan procedures for single-ventricle
congenital heart disease
Oscar A. Ingaramo, MD; Robinder G. Khemani, MD, MsCl; Barry P. Markovitz, MD, MPH; David
Epstein, MD
Pediatr Crit Care Med 2012 Vol. 13, No. 2
Variation of Ventilation Practices With Center Volume After Pediatric Heart Surgery
Punkaj Gupta, MBBS; Xinyu Tang, PhD; Jeffrey M. Gossett, MS; Christine Gall, Dr.PHc; Casey Lauer, BA;
Tom B. Rice, MD; Randall C. Wetzel, MBBS
Clin. Cardiol. (in press)