International Quality Improvement Collaborative

The establishment of surgical programs for children with congenital heart disease in developing world programs is a major step to improve surgical outcomes. Although congenital heart surgery in developing countries offers access to children who would otherwise die, surgery is particularly challenging and associated with high mortality. In 2007, clinical leaders providing surgical cardiac care to children from around the world convened at the Global Forum on Humanitarian Medicine in Cardiology and Cardiac Surgery meeting in Geneva. The topic regarding the existence of potential contributing factors of mortality that may be specific to children receiving cardiac surgery in developing countries was discussed. Conversely, it became evident that few benchmarks exist to identify specific risk factors and evaluate program performance. In an effort to address these gaps, the QI Collaborative was launched. In 2008, Children's HeartLink alongside Boston Children’s Hospital, Humanitarian Association Coeurs pour Tous in Geneva, KM Cherian Foundation in Chennai and Novick Cardiac Alliance in Memphis, TN founded the International Quality Improvement Collaborative for Congenital Heart Surgery in Developing World Countries (IQIC).
The vision of the IQIC is to facilitate a collaborative comprised of healthcare teams from around the world working to create a culture of patient safety and sustainable quality improvement infrastructures for children receiving congenital heart surgery in developing world programs.
The mission of the IQIC is to reduce mortality and major complications for children undergoing congenital heart surgery in developing world programs. To achieve our goals the collaborative aims to:

  • 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 and skills.

A database was created to track clinical outcomes of in-hospital and 30-day mortality, surgical site and blood stream infections, as well as other critical indicators for congenital heart surgery. The database was piloted in 2008 with five pediatric cardiac programs from around the world. Findings from that period indicated data collection on mortality and major complications was feasible among developing world programs, nutritional status is an important risk factor for mortality, and post-operative infections contribute significantly to mortality. The number of participating sites has grown to 44 sites in 22 countries.
The IQIC is managed by Boston Children's Hospital and has a mission to reduce in-hospital and 30-day mortality and major complications for children undergoing congenital heart surgery in developing world programs. To achieve this goal the collaborative partners will identify risk factors related to mortality specific to developing world programs, examine risk-adjusted mortality across developing world programs, provide comparative benchmarking data to evaluate program performance and construct a collaborative framework for sustainable quality improvement in developing world programs. 

IQIC data show that participating institutions realized significantly lower rates of post-surgical infection and mortality since joining the collaborative. (Jenkins et al. 2014 Reducing Mortality and Infections after Congenital Heart Surgery in the Developing World. Pediatrics, 134(5):e1422-30)

Over 51,000 surgical procedures have been entered into the database, and surgical teams from 45 sites in 22 countries benefit from educational webcasts from Boston Children’s Hospital that range from team-based practice to nurse empowerment to infection prevention and safe perioperative practices.

  • In 2014, five of Children’s HeartLink’s partner hospitals were compared to their peers in the IQIC. Surgical site infections at five partner hospitals working with Children’s HeartLink since 2010 decreased from 7.6% to 1.7% in 2014. Bacterial sepsis decreased from 20.4% to 6.3% in the same period, and other major infections decreased from 22.5% to 7.7%.
  • From 2010 to 2014, surgical site infections in postoperative patients decreased from 18.3% to 2.9% at Hospital da Criança e Maternidade in São José do Rio Preto, Brazil.
  • In a region with extremely long waiting lists, our partner hospital Nhi Dong 1 in Ho Chi Minh City, Vietnam, increased patient volume five-fold in just 2 years: from 3,308 patients in 2013 to 15,345 in 2015. It has doubled the number of surgeries since the partnership began, from 162 in 2008 to 335 surgeries in 2015, while also increasing the number of complex surgical cases.
  • Institut Jantung Negara in Kuala Lumpur, Malaysia, has more than doubled the volume of open heart surgical cases in infants under one year old, from 94 infants in 2007 to 278 infants in 2014.
  • West China Hospital in Chengdu reduced its postoperative mortality rates from 4% in 2008 to 1.2% in 2014, and during that time period the case mix became increasingly complex.

Passing on Lifesaving Knowledge

We work in concert with our dedicated medical volunteers, as well as governments and other organizations, to provide training, mentoring and capacity building opportunities designed to meet the unique needs of each partner hospital.