NSF CHOT IUCRC PROGRESS REPORT – PROJECT # 14
Practice Variance: Outcome-Driven Process Redesign & Systems Optimization:
I. Pediatric Heart Network Practice Variance: Collaborative Learning
Research team
Eva K Lee, Jinha Lee, Ankit Agarwal, Georgia
Tech
Description
It is recognized significant practice variation exist
in early post-operative management among
pediatric cardiac centers. This variation may
impact important outcome measures. A large
factor is the variation in patient characteristics
and risk factors. Non-patient factors include
experience, resources, and experimentation.
Some centers may commit greater resources to
certain procedures. Other centers may
encourage experimentation, resulting in
adoption of changes in surgical and medical
care that appear promising and divergence in
management practices from those at other
institutions. Practice variance is an important
issue to analyze as a means to optimize care
delivery (quality and efficiency) and to
encourage collaborative learning for broad
quality improvement. This study will focus on the
entire process of congenital heart surgery from
surgery to end of post-operative care. We aim to
identify potential improvement..
How is this different than related
research? This is a nationwide collaborative
study that involves multiple pediatric heart
centers. Site visits and observation may be
particularly valuable in quality improvement for
congenital heart surgery given critical role of
communication among various clinical teams
(anesthesiologists, surgeons, cardiologists, nurses
and others) involved in the care of an individual
patient. Collaboration with both inter-facility and
intra-facility has the added potential of
stimulating new ideas for investigation or new
management techniques, and increases our
ability to conduct prospective research in a
highly specialized clinical setting.
Experimentation and discussion among
colleagues can lead to the rapid adoption of
innovations and avoid the replication of
disadvantageous techniques. Collaborative
learning in pediatric cardiac surgery requires a
multi-institutional approach due to relatively low
volumes. A national structure for collaborative
site visits has never been tried, to our knowledge,
in any field.
Milestones achieved to date
We report herein work completed for this study so
far. In particular, we have:
 Performed on-site observation, documentation
and contrast of practice variance across five
sites: CHOA, CHOP, C.S. Mott Children’s,
Primary Children’s and Texas Children’s
 Established process maps, workflow and
procedures occurring in OR, ICU, step-down
and discharge unit. Duration, decision making
process, patient care steps and coordination
were documented.
 Summarized and contrast causes of practice
variances and potential impacts;
 Consensus development to collaboratively
establish best practice and new clinical
practice guideline (CPG).
 Implemented procedural change for care
improvement following CPG.
 Evaluate awareness of new CPG in key staffs of
all five sites.
 Completed and submitted a paper “Practice
Variance Analysis for Process Improvement in
Post-Operative Care of Congenital Heart
Surgery” to the American Medical Informatics
Association.
Next Steps
 Evaluate outcome findings and compare
before and after CPG implementation results.
 Improve CPG through collaborative feedbacks.
 Establish CPG for broad national dissemination.
Potential member benefits
 Improve quality and efficiency of care, and treatment outcome for patients
 Facilitate successful dissemination of best practice
 Reduce length-of-stay through early extubation
 Improve care coordination and management
 Establish new CPG for broad national dissemination