Table 3

Detail of quality audit variables at different congenital cardiac levels

MetricDefinitionNumeratorDenominatorTargetComments
PCCSL-2
Diagnostic accuracy rate*The proportion of potentially preventable and clinically important inaccurate diagnoses among congenital heart surgical patients
Minor: no change in patient plan
Moderate: change in plan but no harm
Severe: catastrophic event/death
Number of inaccurate diagnosesNumber of CHD scans doneMinor: <5%
Moderate: <2%
Severe: 0%
This will be done as previously described taxonomy of diagnostic error in congenital echocardiography.35 40
PCCSL-3 (in addition to above metrics)
ICU and inpatient complications rateCAUTI, CLABSI, VAP, soft tissue infections<5/1000 central line days. <5/1000 urinary catheter days.
<5 VAP/1000 ventilator-days.
10% soft tissue infections
Programmes can follow standard defintions and methods to calculate CAUTI, CLABSI, VAP and soft tissue infections.
Standard report per 1000 line/catheter/ventilator days can be used for tracking these metrics.
Crude mortality rateNumber of mortalitiesNumber of patients admitted<10%Since programmes are not expected to be on a registry at this level, targets can be set internally with a focus on consistent improvement.
ICU LOSMean/median LOS in ICUExpected LOS in ICU according to lesion
Emergent cardiac catheterisation procedure outcomesCrude mortality rate in hospital after emergent cardiac catheterisationNumber of mortalities attirbuted to the emergent procedure.Number of emergent procedures performed in a year<10%
Regular M&M meetingsNumber of M&M meetings conducted per year>2
PCCSL-4 (in addition to above metrics)
Safety and outcomes of cardiac catheterisation procedures
  1. Median radiation based on radiation exposure category

  2. Standardised level 3–5 adverse event rates

At this level and above, centres will be expected to be on a QI registry such as IQIC to ensure regular data collection and benchmarking.
Cumulative data (median
length of ICU or hospital stay, mortality rates, etc) from IQIC reports can be used to create benchmarks.
Safety and outcomes of cardiac surgery procedures
  1. Hospital and ICU LOS

  2. Standardised major infection ratio

  3. Crude mortality ratio

  4. Standardised mortality ratio

  5. Major morbidity (tracheostomy, insertion of PPM due to postoperative heart block, diaphragm paralysis, reintubation) rate

  6. Standardised major morbidity ratio

 Fetal diagnostic error rate*This measure provides a mechanism for fetal echocardiography laboratories to record and analyse diagnostic discrepancies between fetal and postnatal findingsNumber of fetal patients with a moderate or severe discrepancy between prenatal and postnatal diagnosisFetuses born during the quarter with prenatal CHD diagnosis needing intervention within first year of life<5%Comparison of prenatal imaging findings and reports with postnatal investigations and reports or repeat fetal echocardiogram.
 Residual lesion scoreTo keep a record of residual lesion based on predischarge postoperative echocardiogramNumber of procedures with RLS category 3 or more56 Total number of surgeries performed<10%
 MDCSafety of surgical proceduresCases discussed in MDCTotal number of surgeries100%To ensure that all cases undergo MDC.
PCCSL-5 (in addition to above metrics)
 TEE accuracy rate* Accuracy of pre-operative diagnosis based on TEETotal number of pre-operative TEEs with one or more major discrepancies identified within 24 hours of surgeryTotal number of pre-operative TEEs performed0%Postcardiac surgery TEE, retrospective medical record review and operative reports.
 TEE adverse events rate*Rate of adverse events associated with TEENumber of TEEs with adverse events identified during a TEE assessmentTotal number of TEEs performed<2%
 Bounce back rateRate of readmissions to ICUNumber of patients shifted back to ICU within 24 hoursNumber of patients shifted from ICU to ward<2%To ensure nursing staff in step-down units/wards are well trained. Also to avoid early, inappropriate shifting of patient from ICU.
 Lifelong follow-up care rateAdherence to lifelong CHD care guidelines60 Number of patients in whom lifelong follow-up guidelines are being followedTotal number of patients with CHD in the programme>80%
  • *Metrics adapted from the non-invasive ACPC QNET network.51 52

  • ACPC QNET, Adult Congenital and Paediatric Cardiology Quality Network; CAUTI, catheter-associated urinary tract infection; CHD, congenital heart disease; CLABSI, central line-associated bloodstream infection; ICU, intensive care unit; IQIC, International Quality Improvement Collaborative; LOS, length of stay; MDC, multidisciplinary conference; M&M, morbidity and mortality; PCCSL, paediatric and congenital cardiac service levels; PPM, permanent pcemaker; QI, quality improvement; TEE, trans-oesophageal echocardiography; VAP, ventilator-associated pneumonia.