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VPS Cardiac Why “VPS Cardiac” is Different Howard Jeffries MD/MBA Medical Director, Accountable Care - Seattle Children’s Hospital Jennifer Daufeldt RN.

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Presentation on theme: "VPS Cardiac Why “VPS Cardiac” is Different Howard Jeffries MD/MBA Medical Director, Accountable Care - Seattle Children’s Hospital Jennifer Daufeldt RN."— Presentation transcript:

1 VPS Cardiac 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

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3 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

4 CurrentVPSCardiac Units 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 AngelesLos Angeles CA Children's Hospitals and Clinics of MinnesotaMinneapolis MN Children‘s Healthcare of Atlanta – Egleston Atlanta GA UCSF Benioff Children's Hospital San Francisco CA Alfred I. DuPont Hospital for Children Wilmington DE Arnold Palmer Hospital for Children Orlando FL Walt Disney Pavilion at Florida Hospital for Children Orlando FL

5 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 VPS Current VPS Mixed Units

6 Cardiac Specific Comparison Reports

7 Table of Contents: The Bonus of Cardiac Reporting

8 Cardiac Medical Patients

9 Cardiac Surgical Patient Analysis

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11 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, Acid- Base/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

12 Pediatric Index of Cardiac Surgical Intensive Care Mortality

13 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 PICSIM

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15 Dr. Jeremy Affolter…………….. Children's Hospital of Wisconsin 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. Sylvia del Castillo……………. Children's Hospital Los Angeles 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. Erica Molitor-Kirsch…………... The Children’s Mercy Hospital Dr. Rebecca Russell ……………… Children's Hospital of Wisconsin Dr. Janet Simsic ……………………. Nationwide Children's Hospital Dr. Michael Wolfe ………. Children‘s Healthcare of Atlanta - Egleston Cardiac Advisory Group Current Members 2015

16 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

17 COMPLICATIONS LIST Bleeding Requiring Reoperation Cardiorespiratory Arrest Chylothorax New Onset Seizure Pericardial or Pleural Effusion Requiring Drainage Phrenic Nerve Injury Post Procedural Arrhythmia Requiring 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 CURRENT PROJECT

18 COMPLICATIONS LIST (CONTINUED) (CONTINUED)

19 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 STS- CHSD (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

20 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 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 March 2014 Volume 15 Number 3 PUBLISHED RESEARCH ARTICLES

21 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) PUBLISHED RESEARCH ARTICLES


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