1. International Quality Improvement Collaborative for Congenital Heart Surgery
Hello everyone and thank you for joining us.
Welcome to the International Quality Improvement Collaborative for Congenital Heart Surgery in Developing Countries.
We are very excited to present a database refresher webinar to all of you.

2. Vision
Facilitate a collaborative of healthcare teams from around the world creating a culture of patient safety & quality for children receiving congenital heart surgery in developing countries
As many of you are familiar with already, the International Quality Improvement Collaborative vision is to facilitate a collaborative of healthcare teams from around the world creating a culture of patient safety and quality for children receiving congenital heart surgery in developing countries.

3. Mission
Our mission is to reduce mortality and major complications for children undergoing congenital heart surgery.
Our mission is to reduce mortality and major complications for children undergoing congenital heart surgery.

4. Objective
Create tailored quality improvement strategies to reduce mortality and major complications for developing world programs.
Employ a telemedicine platform to facilitate distance learning, dialogue, disseminate knowledge & skills.
We hope to achieve this mission by creating tailored quality improvement strategies to reduce mortality and major complications as well as by employing a telemedicine platform to facilitate distance learning, dialogue, and the dissemination of knowledge and skills.

5. Drivers of Mortality Team-based practice through nurse empowerment
Reduce surgical site infections and bacterial sepsis
Safe perioperative practices
Three key drivers of mortality have been identified: Team-Based practice through nurse empowerment, reduction of surgical site infections and bacterial sepsis, and safe perioperative practices.

6. Database Refresher November 18, 2010
Today’s webinar will be a refresher lecture on how to access and use the IQIC database.

7. Importance of Data
Standardized benchmarking data will identify drivers of mortality and life-threatening complications, as well as guide the development of targeted QI strategies.
Enable programs to evaluate performance, identify strengths and opportunities for improvement, and track progress over time.
Utilize for external comparative benchmarking to determine where programs stand in relation to their peers.
To start, we would like to review the importance of collecting data. The benchmarking data helped to identify drivers of mortality and life threatening complications, as well as guided the development of the quality improvement webinars. By entering data, your hospital will be able to evaluate your performance over time, as well as identify your strengths and opportunities for improvement. This data will also be used to compare to external benchmarks to determine where your hospital stands in relation to your peers.

8. Outcome Measures Primary Outcomes: In-hospital and 30 day mortality
Risk adjustment based on RACHS-1
Secondary Outcomes:
Blood stream infection/bacterial sepsis
Surgical site infection
Both primary and secondary outcomes are being tracked. Primary outcomes are defined by in hospital and 30 day mortality and are risk adjusted based on RACHS-1 scores.
Secondary outcomes are defined as:
Occurrence of blood stream infection/bacterial sepsis: which is defined as known or presumed bacterial sepsis with fever or hypothermia, tachycardia, hypotension, tachypnea, leucocytosis or leucopenia.
Occurrence of surgical site infection, which must meet the following criteria:
-Infection occurs within 30 days after the operative procedure and involves only skin and subcutaneous tissue of the incision, and patient has at least 1 of the following:
-Drainage from the superficial incision, and organisms have been isolated from a culture, or
-At least 1 of the clinical signs or symptoms of infection, such as pain or tenderness, localized swelling, redness or heat.

9. RACHS-1 Validated in multi-institutional data sets
Procedures are grouped into six risk categories
Additional clinical factors
Age group
Prematurity
Major non-cardiac structural anomaly
Risk adjustment for mortality is performed using the Risk Adjustment for Congenital Heart Surgery (RACHS-1) method. Each surgical procedure is assigned to 1 of 6 predefined risk categories, based on the RACHS-1 method. Risk category 1 poses a low risk for death, while category 6 has a high risk for death. Additional clinical factors integrated into the RACHS-1 adjustment include age, prematurity, and major non-cardiac structural anomaly. The RACHS-1 method has been validated and applied to databases in the U.S. and Europe.

10. RACHS-1Risk Categories
A list of congenital diagnoses along with the corresponding RACHS-1 score were included in the Database reference guide. Please refer to this guide for any questions. As you can see the categories are rated based on complexity from 1 to 6, 6 being the most complex.

11. Remote Data Capture
Diagnostic, procedural, and clinical data are entered into the database via a web-based tool.
Entering data remotely is easy and only requires an internet connection and standard web browser.
The database is maintained at Children’s Hospital Boston.
Diagnostic, procedural, and clinical data are captured remotely and are entered into the database via a web based tool. Entering data remotely is easy and only requires an internet connection and a standard web browser. The database is maintained at Children's Hospital Boston.

12. Data Capture Process Data Entry Query Process Database Lock
Quarterly Reports
The data capture process consists of data entry, the query process, database lock, and the distribution of quarterly reports.

13. Data Entry
To gain access to the database or if you have problems with data entry contact:

14. Query Process
Cleaning the data includes looking for missing data or other data-related issues.
Workbooks will be sent to collect missing data.
Please respond to data queries in a timely manner to prevent delays in submitting your data.
The query process involves cleaning up the data that has been entered in to the database. It is an important part of data capture. Cleaning the data includes looking for any missing data or other data-related issues. If there is any missing data or questions, you will receive an excel workbook that includes this information. Please respond by resolving these issues when the excel workbook is sent to you.

15. Database Lock
Database lock refers to the completion of data entry and resolution of queries as the database is locked and the report is then generated.
During the query process each quarter, you will have a deadline for completing data entry and a deadline to respond to all data queries.
At the end of each data capture period, the database will be locked, meaning that data entry should be completed and queries should be resolved so reports can be generated. You will have a deadline to complete data entry as well as a deadline to respond to all data queries.

16. Quarterly Reports
Each site will receive a confidential quarterly report including a summary of outcome data for their site.
All sites will receive an annual report including cumulative results of their data as well as cumulative results from all participating sites.
Read off slide

17. Data Capture and Reporting
Data Capture Timeline
Data Capture and Reporting
Data Capture Period
Data Entry
Reports
Q1 2010
Jan 1-Mar 31
4/15/10
5/28/10
Q2 2010
Apr 1-Jun 30
7/14/10
8/25/10
Q3 2010
July 1-Sep 30
10/14/10
11/25/10
Q4 2010
Oct 1-Dec 31
1/14/11
2/25/11
Children’s Hospital Boston will maintain the project database. Data from the database is exported to generate confidential quarterly reports for each site. Benchmarking data can be used to evaluate program performance and drive quality improvement at your institutions. This slide represents the 2010 data timeline which provides the time periods captured by each quarter, as well as when the data entry for that quarter will need to be completed by, and when you can expect to receive your quarterly reports from Children’s Hospital Boston. You should have received two reports thus far.

18. Using the Database
We will now discuss how to use the database.

19. Data CRF & Entry Process
This section will go through the step by step process of collecting the information for the Case Report Forms (CRF) and entering it into the database.
Forms 1-6 are located in your Database Reference Guide. Please refer to this guide for further details.

20. https://c3po.chcvp.org/INTL/
Home Page
Once you enter the web address for the IQIC website, you will be brought to the home page.

21. Logging In
In order to successfully login to the application, you must enter a valid user-name and password in the designated fields of the Welcome Page. Once you have successfully logged in, the screen will appear unchanged. You will, however, find that the six menu options located at the top of the page will become active links at that point.
Once logged in, you will have the option of clicking on any of the six menu options listed at the top of the page, which are:
Home
Enter New Patient
Search New Patient
Media
Forum
Contact Us
By clicking on the Home tab- you will be brought back to the home page.

22. Search Patient
When you click Search Patient, you will be taken to a new screen displaying a grid of all patients from your institution. This allows you to add, edit and delete patient data. Initially, this grid will be blank, but will become filled with data as you add patients into the system. When you click on Search Patient, the following screen will be displayed.

23. Demographic Information
CRF1 –
Demographic Information
When you click on Enter New Patient, a new screen will open to Form 1 (Demographic Information) and you will see the following screen. Please note that you can access Form 2 through 6 directly from the menu on the left side of the screen.
AutoFill- automatically fills in patient contact and demographic information based on the patient ID Number. This applies to new admissions for patients that have previously been entered into the system.
Save- saves current case data.
Save and Close- saves current case data and exits the data entry screen.
Close- prompts user to save any entered data and exits the data entry screen.
On this screen you will enter patient name, date of birth, age at surgery, gender, ethnicity, and address.

24. CRF2 – Pre-Operative Status
When you click on Form 2, on the left side of the screen, you will see the following, and you will enter the pre-operative status of the patient including the data variables: nutritional appearance, preoperative procedures, weight, height, hematocrit, oxygen saturation, prematurity status, and any other important information. Nutritional appearance has several options which are defined as:
Normal: within normal ranges of height and weight for patient’s age
Malnourished: below normal ranges of height and weight for patient’s age
Emaciated: extreme thinness, which can include loss of muscle and fat tissue
Overweight: above normal ranges of height and weight for patient’s age

25. CRF3 – Patient Diagnosis
When you click on Form 3, on the left side of the screen, you will see the following. This is where the patient diagnosis is entered, both cardiac and non-cardiac. Note that more than one diagnosis can be added. For cardiac diagnoses, click on the “Add Diagnosis” button and you will be given options to select from. For non-cardiac diagnoses, you are asked to answer yes or no if these are a major non-cardiac structural anomaly, a major chromosomal abnormality or syndrome, or a major medical illness. If the response to any of these is “yes” please describe.

26. CRF4 – Surgical Procedure
When you click on Form 4, on the left side of the screen, you will see the following. This is where you are asked to enter details about the surgical procedure performed as well as a RACHS-1 risk category to the procedure performed. The data variables that you will enter on this screen include: a description of the surgical procedure including the name of the procedure, the date of surgery, the name of the surgeon and other persons assisting, whether or not the procedure was performed in the presence of visiting cardiac surgical groups, the number of operations or reoperations prior to surgery, whether or not the chest was open after surgery, whether or not additional surgery was required for bleeding and if yes, describe. To assign the RACHS-1 category, click on the “Assign risk category based on procedure performed” button. You will then see 6 folders open in a new window. They are named Risk Category By double-clicking on each of the folders you can find which risk category the procedure corresponds to. Finally, you will enter any other pertinent medical information.

27. CRF5 – Outcome/Complications
When you click on Form 5, on the left side of the screen, you will see the following, which asks for Outcomes and Complications. The data variables you will enter on this screen include: date of hospital discharge, whether or not there was an in-hospital death and if yes, what is the date of death and describe. You will then enter the length of time spent in the ICU and ventilation time in hours and minutes. You will answer yes or no if there were any perfusion issues and if yes describe. Then answer yes or no if there was a surgical site infection and if yes, specify. There is a drop down which includes options for you to select from. Then answer yes or no if there was bacterial sepsis and if yes enter the organism identified if it is known and describe. Then enter any other major complications. A more thorough description of each complication listed is provided in your database use manual.

28. CRF6 – 30 Day Follow-Up
When you click on Form 6, on the left side of the screen, you will see the following assessing 30 day follow up. The data variables you will enter on this screen include:
Date of Patient Contact- Please try to follow-up with patient within days. This will ensure that, should the 30-day follow-up fall on a Sunday, contact can still be made with the patient. If it is unreasonable for the patient to come back to the clinic for the follow-up, please attempt to make contact with the patient via phone or .
Then you will answer yes or no regarding if the patient is alive. If the patient is not alive, you will enter the date of death. If the patient is alive, you will enter how the patient was contacted. There is a drop down menu with options for you to choose from or you can enter it in the “other” field if it is not in the drop down list. Then you will answer yes or no regarding if the patient is okay and describe their current condition.

29. Webinar Recordings
When you click Media, you will be taken to a new screen displaying a list of all previous IQIC webinars presented by Children's Hospital Boston. The most recent presentation will always be at the top of this list. For your convenience, the Title, Description, and Date of each presentation have been included. A new screen will be generated which will prompt the recorded presentation to begin playing. You will have the ability to pause, rewind, and skip ahead to a particular point in the presentation at your leisure.

30. Discussion Boards
The newest feature of the database is our Discussion Boards. In order to post a comment or question, choose Forum from options at the top of the screen. This will bring you to 3 discussion boards, one for each key driver- Team Based Practice, Infection Control, and Safe Perioperative Practice. Choose which board you would like to post in and click New Topic. This will allow you to type in questions and comments, which will be posted to the board. These boards are monitored by the IQIC team and any posts will be answered.

31. Contact Us
You may communicate with us through the contact screen. You will need to enter your name, address, select the individual you wish to contact and enter your message. Click the Send button at the bottom of the screen to send the . We recommend that you do not send highly personal (including demographic), medical, or confidential information. We will try to respond to all inquiries within two business days. When you click on Contact Us, the following screen will be displayed.

32. Thank You
Thank you very much for participating in the International Quality Improvement Collaborative. We hope this webinar will be helpful to you in using the website for data entry questions, to listen to previously recorded webcasts, and to communicate with other participating sites and the team in Boston.