Quality improvement initiative in paediatric echocardiography laboratory in a low- to middle-income country

Objective: To determine the impact of quality improvement (QI) initiative in the area of pediatric echocardiography in a low to middle income country (LMICs).Background: Care for patients with congenital heart disease is challenging especially in LMICs. Collaborative learning through QI projects is imperative to ensure improvement in delivery processes leading to better patient outcomes.Methods: This QI initiative was taken by a team consisting of physician and sonographers. Problems were identified, a key driver diagram (KDD) was created, and simple process reengineering was done using interventions based on the KDD. Metrics (5 process and 1 outcome) were assessed to determine the effectiveness of the QI project. The process metrics assessed were comprehensiveness of exam, timeliness of reporting, diagnostic accuracy and error, and sedation adverse event rates of transthoracic echoes while a novel comprehensive echocardiography laboratory quality score was developed as an outcome metric. Data were collected quarterly and analyzed in the post-implementation phase.Results: Significant improvement was seen in comprehensive mean score (20.4 to 29.7), timeliness (40% to 95%), diagnostic accuracy rate (91% to 100%) while a decrease was seen in diagnostic error rate (7.5% to 3.5%) and the sedation adverse events rate (6.8% to 0%), pre vs post implementation. The overall quality outcome score improved from 7 to 19 and the Echo Lab was able to achieve adequate quality.Conclusion: Significant improvement was seen in all the processes, and overall quality of the Echo Lab without any substantial increase in resources or cost

Health Care Policy and Congenital Heart Disease: 2020 Focus on Our 2030 Future

The congenital heart care community faces a myriad of public health issues that act as barriers toward optimum patient outcomes. In this article, we attempt to define advocacy and policy initiatives meant to spotlight and potentially address these challenges. Issues are organized into the following 3 key facets of our community: patient population, health care delivery, and workforce. We discuss the social determinants of health and health care disparities that affect patients in the community that require the attention of policy makers. Furthermore, we highlight the many needs of the growing adults with congenital heart disease and those with comorbidities, highlighting concerns regarding the inequities in access to cardiac care and the need for multidisciplinary care. We also recognize the problems of transparency in outcomes reporting and the promising application of telehealth. Finally, we highlight the training of providers, measures of productivity, diversity in the workforce, and the importance of patient– family centered organizations in advocating for patients. Although all of these issues remain relevant to many subspecialties in medicine, this article attempts to illustrate the unique needs of this population and highlight ways in which to work together to address important opportunities for change in the cardiac care community and beyond. This article provides a framework for policy and advocacy efforts for the next decade