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:
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.
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.