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Enhancing Quality in the Pediatric Cath Lab

Enhancing Quality in the Pediatric Cath Lab

According to published estimates, about one in 110 babies in the United States is born with congenital heart disease. On the surface, the incidence of the disease is relatively low, but the consequences can be profound. New, rapidly evolving interventional treatments are extending lives and enhancing the quality of life for children living with congenital heart disease. These advancements are driving a need for quality tools that are specific to pediatric interventional cardiology. In 2014, the Society for Cardiovascular Angiography and Interventions (SCAI) unveiled a new resource that is designed to help pediatric cardiac catheterization laboratories continuously improve care. The resource—called the Pediatric SCAI Quality Improvement Toolkit, or Pediatric SCAI-QIT—provides clinicians with a comprehensive toolkit that complements the adult SCAI-QIT for catheterization laboratories. Introduced by SCAI in 2011, the adult SCAI-QIT features regular updates on continuous quality improvement, accreditation, peer reviews, measurement, public reporting, and patient and physician education. Fulfilling a Need “Pediatric quality improvement requires specific tools and resources that are tailored to the unique medical needs of children,” says Henri Justino, MD, FSCAI, who is also chair of the Pediatric SCAI-QIT. “The toolkit was created by the cardiology community to help cardiologists optimize care for children with congenital heart disease.” The Pediatric SCAI-QIT includes four modules: 1. Catheterization Conferences: Addresses communication that should occur in catheterization laboratories. 2. Procedural Checklists: Reviews action items before, during, and after catheterization procedures. 3. Radiation Safety: Describes the rationale and strategies for reducing radiation exposure to patients and staff. 4. Procedural Quality: Discusses the rationale and overriding goals of quality improvement. “The modules are flexible so that each institution can adopt...
Complications

Complications

Yesterday I readmitted two patients to the hospital with surgical complications. One was a man who had a colon resection 6 weeks ago. He has had the ‘dwindles’ since discharge. He’s lost weight, has no energy and no appetite. A CBC done yesterday showed his white blood cell count was elevated, and a metabolic panel shows impending renal failure. I suspect he has an intrabdominal abscess despite the fact that he has no fever. The second patient is 3 weeks out from a complex incisional hernia repair that involved reconstruction of her entire abdominal wall with placement of a large sheet of surgical mesh under the muscle layers. She is a morbidly obese diabetic and has developed a wound infection. If the infection reaches the mesh, I’ll have to remove it, undoing her entire repair. Complications are a fact of life in surgery. No matter how good a surgeon you are, no matter how carefully you manage patients, something will go wrong once in a while. As my Chief was fond of saying, “If you do big surgery, you get big complications.” Intellectually I know this. But days like yesterday try my soul. The first thing I ask myself when a patient has a complication after surgery is, “What did I do wrong?” Did I make a technical error? Did I miss some critical sign or lab value? I’m not comfortable until I’ve looked for those things, and even then feel that I must have missed something. This is the default mode for most surgeons I know. That type of thinking is built into our training. The ritual of...
AHA 2014

AHA 2014

New research is being presented at AHA 2014, the annual scientific sessions of the American Heart Association, from November 15 to 19, in Chicago.     Meeting Highlights Dual Antiplatelet Therapy After Stenting Heart Ischemia & Stress in Women With CAD Persistent Asthma Linked With CVD Screening for CAD in Patients With Diabetes Can Overtreatment of AF Increase Dementia Risk?   News From AHA 2014 Pregnant women with congenital heart disease may have low complication risks during delivery Trans Fat Consumption is Linked to Diminished Memory in Working-aged Adults Early detectable vascular disease linked to erectile dysfunction Moms’ pre-pregnancy weight impacts risk of dying decades later Cocaine users experience abnormal blood flow, risk heart disease AHA Perspective on the Potential Impact of the IMPROVE-IT Data Cholesterol-lowering drug with different action adds to statin’s reduction of cardiovascular risk New York medical professor receives AHA Chairman’s Award for leading initiatives on diversity, equity in education and healthcare San Francisco scientist wins AHA Research Achievement Award for ‘transcendent’ findings of blood clot controls leading to new therapy Boston scientist awarded American Heart Association prize for translating bench research into identifiable markers of CVD risk American Heart Association council honors Iowa cardiologist for his distinguished career benefitting physicians and their patients Mayo Clinic scientist awarded AHA research prize for applying newest technologies to advance diagnosis, treatment of cardiovascular disorders AHA awards Clinical Research Prize to New York cardiologist for leading landmark trials creating guidelines for heart patient care Poison control data show energy drinks and young kids don’t mix  Individualize DAPT Duration Screening or Treating to Goal Equally Effective IMPROVE-IT Reactions Act Two...
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