Pediatric Cardiology Quality Improvement
Pediatric Cardiology Quality Improvement
Introduction
The Department of Pediatrics and the Division of Cardiology recognize the importance of quality improvement in healthcare. With a common vision, our team is inspired and energized by the idea of improving outcomes for our patients while supporting our providers through the Quality Improvement process.
Annual QI Theme: “Help Me Stay Well”
In order to service the Heart Center, it’s patients, providers and supporters the QI committee has developed an annual theme. This year’s theme, “Help Me Stay Well” highlights the desire to focus our efforts on delivering exceptional care to our patients and mimics the Heart Center’s Vision “To discover, teach and deliver exceptional cardiac care that enhances the lives of patients and families.”
Team Members:
Our multidisciplinary QI team is made up of members representing major divisions within our Heart Center. It supports the importance of perspective in developing quality care and ensures the unique expertise and understanding that each team member brings to the table.
- Judson Moore, MD Quality Director
- Jennifer Marietta, RN Quality Co-Director, Project Manager
- Emilee Glenn, NP QI Consultant, Project Manager
- Michelle Lynn, RN, Project Manager
- Melissa Winder, NP QI consultant, Project Manager
- Adil Husain, MD CT Surgery
- David Bailly, DO CICU
- Haley Francione, MSN CICU shared leader
- Adam Ware, MD Cardiology
- Marissa Critchlow, RN CCU shared leader
- Chuck Pribble, MD Anesthesiology
- Bethany Marullo, Heart Center Administrative Director
- Tina Wadhwa, MS Senior Data Manager
Current Projects:
Through deliberate support of the QI program and development of it’s team, the Heart Center has collaborated on more than 50 QI projects impacting patients, families and caregivers. Here is a list of our active projects:
| Project Name | PI | Description |
|---|---|---|
| CICU CLABSI Reduction | Megan Wichser | Decreasing CLABSI rate in the CICU |
| Target Based Care (PC4 collaborative) | David Bailly, Kevin Hummel | Better communicating target metrics for key milestones during post-operative recovery |
| Final CICU Etiology | David Bailly | Determining final need for ICU care prior to transfer to step-down unit |
| Final Hospital Need | Adam Ware | Determining final reason for hospital stay prior to discharge |
| Sternal Wound Infection Prevention (SWIP) | Emilee Glenn, Jeremy Harman | Decreasing SSI rate in post-operative CV surgery patients |
| Hearts to Home (PAC3 collaborative) | Adam Ware | Decreasing time to discharge after medial readiness |
| Genetic Counseling Consults in the CICU | Briana Sawyer | Increase number of eligible genetic counseling consults in CICU and decrease time to consult |
| Enhanced Recovery After Surgery (ERAS) | Rusty Eckhauser, Kevin Hummel | Decreasing time to full recovery after surgery |
| VAD Stroke Protocol | Kari Phillips | Improving stroke symptom response for patients with VADs |
| JET Protocol | Claire Newlon | Standardizing the management of post-operative JET |
| Efficiency and Accuracy in the Exercise Lab | Ben Hammond | Improving exercise lab throughput and obtaining more appropriate testing type based on indication |
| Social Determinants of Health screening | Leandra Bitterfield | Implement SDOH screening in HF/transplant clinic and make appropriate resource allocation |
| Implementation of Bystander CPR Training | Yuki Asaki | Implementing a bystander CPR training program for patients and families at a community pediatrics clinic |
| Decreasing transport time of high risk CHD deliveries | Whitnee Hogan | Decreasing the transport time of high risk CHD newborns from the U NICU to PCH. |
| Nursing Burnout | Chelsea Buckalew | Reducing the total percent of CICU, CCU, and MCS nurses in the "burnout" profile |
| CCU Diaper Rash Prevention | Whitney Cazier | Decreasing diaper rash rate for CCU patients under 24 months of age |
| CT Imaging and Sedation | Corinne Ballard | Increasing the number of non-sedated patients <1 year of age undergoing Cardiac CT Imaging while maintaining baseline diagnostic image quality |
| Clinical Operations in Pediatric Cardiology | Judson Moore | Decrease median time from referral to patient seen in clinic and from referral to patient scheduled |
| Potassium Replacement in the CICU | Haley Francione | Increasing standard KCl replacement dosing will reduce the median time patients are hypokalemic |
| Growth & Developmental Outcomes in VSD, TOF, AVC | Kacee Muller | Optimizing growth and gross motor development in the preoperative phase in an outpatient setting while promoting positive long-term oral feeding for infants with VSD, TOF, AVC |
Completed Projects:
In the world of Quality Improvement, no project is ever completed but instead falls into a category of Quality Control. The following projects have successfully transitioned into Quality Control.
| Project Name | PI | Description |
|---|---|---|
| Neonatal Cardiac Surgery Lead Time Reduction | Rusty Eckhauser | Decreasing time from admission to OR |
| Moderate Risk Feeding Protocol | Claudia Delgado | Standardize feeding regimen for patients that are not high risk |
| Reducing Radiation Exposure | Bob Gray | Reduce radiation exposure received by CHD patients undergoing cardiac cath |
| PA/IVS Guideline | Bob Gray | Decrease practice variability in medical and procedural management |
| Fontan Pacemaker | Phil Burch/Tom Pilcher | Identifying upcoming Fontan patients who should get permanent pacer leads placed at time of surgery |
| MBSS Guideline | Courtney Jones | Establishing a guideline for when modified barium swallow study is needed |
| Improving Echo Interpretation | Sara Hooper | Improve accuracy of diagnosing PHTN by NICU providers |
| Syncope Practice Guideline | Collin Cowley | Reducing unnecessary diagnostic testing in pediatric syncope |
| Cardiac Arrest Prevention (CAP) | Trudy Hardin-Reynolds / PC4 | Determine epidemiology of CAP in patients with CHD and prevention of cardiac arrest |
| Nasotracheal Intubation | Chuck Pribble | Intubating neonates nasally for surgery to allow for PO feeding/oral skills sooner |
| Inequalities in Neurodevelopmental Care | Kristi Glotzbach | Increase the number of referrals to HCNP |
| Partners in Developmental Care | Lauren Malik | Improve developmental care in the CICU and CCU evidenced by documentation of 5 process measures |
| School-Age Patient Referral to HCNP / CNOC | Kristi Glotzbach | Recognize and document high-risk ND status and referral for formal ND evaluation |
| Chylothorax (multiple) | Melissa Winder | Decreasing time for fat-free diet, establishing testing protocol |
| Standardized Discharge Furosemide (PAC3 collaborative) | Adam Ware | Standardizing and reducing the use of post-operative furosemide after hospital discharge |
Published Projects:
- Headrick, A., Wawrzynski, S., Moore, J., Winder, M., Masih, J. R., De Leon Jauregui, M., Flaherty, B., Moresco, B., Millar, M. M., Codden, R. R., Moore, D., & Delgado-Corcoran, C. (2025). Increasing Pediatric Palliative Care Consultation for Patients with Heart Disease and Prolonged Cardiac Intensive Care Stay, Pediatric quality and safety, 10(2):e796. https://doi.org/10.1097/pq9.0000000000000796
- Buehne, K.L., Winder, M., Marietta, J., Park, J., Dwyer, M., Eckhauser, A.W., & Hummel, K. (2024). A qualitative needs assessment of early participants in an Enhanced Recovery After Surgery program in CHD, Cardiology in the young, 34(11):2323-2328. https://doi.org/10.1017/S104795112403600X
- Winder, M.M., Ware, A., Husain, A., Griffiths, E., Swink, J.M., Ou, Z., & Eckhauser, A. (2024). Interdigitating Technique for Repair of Aortic Arch Obstruction to Reduce Reintervention Rates, The Annals of thoracic surgery, 117(2):387-394. http://doi.org/10.1016/j.athoracsur.2023.06.015
- Glenn, E. T., Harman, J. R., Marietta, J., Lake, J., Bailly, D. K., Ou, Z., Griffiths, E. R., & Ware, A. L. (2023). Impact of a Surgical Wound Infection Prevention Bundle in Pediatric Cardiothoracic Surgery. The Annals of thoracic surgery, 115(1), 126–134. https://doi.org/10.1016/j.athoracsur.2022.08.045
- Moza, R., Winder, M., Adamson, G. T., Ou, Z., Presson, A. P., Vijayarajah, S., Goldstein, S. A., & Bailly, D. K. (2023). Prediction Model with External Validation for Early Detection of Postoperative Pediatric Chylothorax. Pediatric cardiology, 44(6), 1367–1372. https://doi.org/10.1007/s00246-022-03034-4
- Winder, M., & Bailly, D. (2023). Pediatric chylothorax: where we've been and where we're going. Journal of thoracic disease, 15(4), 1526–1529. https://doi.org/10.21037/jtd-23-7
- Winder, M. M., Ware, A., Husain, A., Griffiths, E., Swink, J. M., Ou, Z., & Eckhauser, A. (2023). Interdigitating Technique for Repair of Aortic Arch Obstruction to Reduce Reintervention Rates. The Annals of thoracic surgery, S0003-4975(23)00678-1. Advance online publication. https://doi.org/10.1016/j.athoracsur.2023.06.015
- Marietta, J., Glotzbach, K. L., Jones, C. E., Ou, Z., Profsky, T. K., Clegg, D., Winder, M. M., & Pribble, C. G. (2022). Assessing the Impact of Nasotracheal Intubation on Postoperative Neonates With Congenital Heart Disease: A Quality Improvement Project at a Single Heart Center. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 23(7), e338–e346. https://doi.org/10.1097/PCC.0000000000002958
- Lion, R. P., Winder, M. M., Amirnovin, R., Fogg, K., Bertrandt, R., Bhaskar, P., Kasmai, C., Holmes, K. W., Moza, R., Vichayavilas, P., Gordon, E. E., Trauth, A., Horsley, M., Frank, D. U., Stock, A., Adamson, G., Lyman, A., Raymond, T., Diaz, I., DeMarco, A., … PC4 Chylothorax Work Group (2022). Development of consensus recommendations for the management of post-operative chylothorax in paediatric CHD. Cardiology in the young, 32(8), 1202–1209. https://doi.org/10.1017/S1047951122001871
- Ware, A. L., Reiter, L., Winder, M., Kelly, D., Marietta, J., Ohsiek, S., Ou, Z., Presson, A., & Bailly, D. K. (2022). The final hospital need in children discharged from a cardiology acute care unit: a single-centre survey study. Cardiology in the young, 1–8. Advance online publication. https://doi.org/10.1017/S1047951122003596
- Winder, M. M., Marietta, J., Kerr, L. M., Puchalski, M. D., Zhang, C., Ware, A. L., & Cowley, C. G. (2021). Reducing Unnecessary Diagnostic Testing in Pediatric Syncope: A Quality Improvement Initiative. Pediatric cardiology, 42(4), 942–950. https://doi.org/10.1007/s00246-021-02567-4
- Kevin Hummel & White B, Algaze C, Marrone T, Sinnott J, Wawrzynski S, Winder M, Bailly D (2021). Standardization without protocolization: Implementing transparent bedside benchmarks to reduce variation in postoperative care. NEJM Catalyst. Published, 05/2021
- Glotzbach, K. L., Ward, J. J., Marietta, J., Eckhauser, A. W., Winter, S., Puchalski, M. D., & Miller, T. A. (2020). The Benefits and Bias in Neurodevelopmental Evaluation for Children with Congenital Heart Disease. Pediatric cardiology, 41(2), 327–333. https://doi.org/10.1007/s00246-019-02260-7
- Winder, M. M., Ou, Z., Presson, A. P., Witte, M. K., Ware, A. L., Marietta, J., Ward, J. J., & Bailly, D. K. (2020). The final reason paediatric Cardiac ICU patients require care prior to discharge to the floor: a single-centre survey. Cardiology in the young, 30(8), 1109–1117. https://doi.org/10.1017/S104795112000164X
Resources:
- Institute for Healthcare Improvement: The Institute for Healthcare Improvement has over 30yrs experience in the science of improvement. Their website has several resources and published white papers describing the framework of Quality Improvement.
- IHI QI Essentials Toolkit: The IHI Essentials Toolkit includes a description of QI tools as well as templates for tools so you can get started.
- Dr. Mike Evans: An Illustrated Look at Quality Improvement in Healthcare: This is an excellent video that introduces the concepts of quality improvement in an easy to watch animated whiteboard video.
Phone: (801)662-5402
Email: HeartCenterQI@imail.org