Metric | Definition | Numerator | Denominator | Target | Comments |
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 diagnoses | Number of CHD scans done | Minor: <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 rate | CAUTI, 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 rate | Number of mortalities | Number 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 LOS | Mean/median LOS in ICU | Expected LOS in ICU according to lesion | – | ||
Emergent cardiac catheterisation procedure outcomes | Crude mortality rate in hospital after emergent cardiac catheterisation | Number of mortalities attirbuted to the emergent procedure. | Number of emergent procedures performed in a year | <10% | – |
Regular M&M meetings | Number of M&M meetings conducted per year | – | – | >2 | – |
PCCSL-4 (in addition to above metrics) | |||||
Safety and outcomes of cardiac catheterisation procedures |
| – | – | – | 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 |
| – | – | – | |
Fetal diagnostic error rate* | This measure provides a mechanism for fetal echocardiography laboratories to record and analyse diagnostic discrepancies between fetal and postnatal findings | Number of fetal patients with a moderate or severe discrepancy between prenatal and postnatal diagnosis | Fetuses 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 score | To keep a record of residual lesion based on predischarge postoperative echocardiogram | Number of procedures with RLS category 3 or more56 | Total number of surgeries performed | <10% | |
MDC | Safety of surgical procedures | Cases discussed in MDC | Total number of surgeries | 100% | To ensure that all cases undergo MDC. |
PCCSL-5 (in addition to above metrics) | |||||
TEE accuracy rate* | Accuracy of pre-operative diagnosis based on TEE | Total number of pre-operative TEEs with one or more major discrepancies identified within 24 hours of surgery | Total number of pre-operative TEEs performed | 0% | Postcardiac surgery TEE, retrospective medical record review and operative reports. |
TEE adverse events rate* | Rate of adverse events associated with TEE | Number of TEEs with adverse events identified during a TEE assessment | Total number of TEEs performed | <2% | |
Bounce back rate | Rate of readmissions to ICU | Number of patients shifted back to ICU within 24 hours | Number 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 rate | Adherence to lifelong CHD care guidelines60 | Number of patients in whom lifelong follow-up guidelines are being followed | Total 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.