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Evaluating variation in pre-operative evaluation and planning for children undergoing atrial or ventricular septal defect repair

Published online by Cambridge University Press:  13 June 2023

Catherine C. Dawson-Gore Open the ORCID record for Catherine C. Dawson-Gore [Opens in a new window] ,
Andrew Well Open the ORCID record for Andrew Well [Opens in a new window] ,
Scott Wallace ,
Elizabeth Teisberg ,
Christopher Born ,
Kathleen Carberry ,
Erin Gottlieb ,
Dudley Byron Holt ,
Charles D. Fraser Jr.  and
Carlos M. Mery
Catherine C. Dawson-Gore*
Affiliation:
Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children’s Medical Center, Austin TX, USA Department of Surgery School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora CO, USA
Andrew Well
Affiliation:
Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children’s Medical Center, Austin TX, USA Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin TX, USA The Value Institute for Health and Care, The University of Texas at Austin Dell Medical School and McCombs School of Business, Austin TX, USA
Scott Wallace
Affiliation:
The Value Institute for Health and Care, The University of Texas at Austin Dell Medical School and McCombs School of Business, Austin TX, USA
Elizabeth Teisberg
Affiliation:
The Value Institute for Health and Care, The University of Texas at Austin Dell Medical School and McCombs School of Business, Austin TX, USA
Christopher Born
Affiliation:
Administration, Dell Children’s Medical Center, Austin TX, USA
Kathleen Carberry
Affiliation:
The Value Institute for Health and Care, The University of Texas at Austin Dell Medical School and McCombs School of Business, Austin TX, USA
Erin Gottlieb
Affiliation:
Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children’s Medical Center, Austin TX, USA Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin TX, USA
Dudley Byron Holt
Affiliation:
Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children’s Medical Center, Austin TX, USA Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin TX, USA
Charles D. Fraser Jr.
Affiliation:
Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children’s Medical Center, Austin TX, USA Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin TX, USA
Carlos M. Mery
Affiliation:
Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin / Dell Children’s Medical Center, Austin TX, USA Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin TX, USA
*
Corresponding author: C. C. Dawson-Gore; Email: catherine.dawson-gore@cuanschutz.edu
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Abstract

Background:

CHD care is resource-intensive. Unwarranted variation in care may increase cost and result in poorer health outcomes. We hypothesise that process variation exists within the pre-operative evaluation and planning process for children undergoing repair of atrial septal defect or ventricular septal defect and that substantial variation occurs in a small number of care points.

Methods:

From interviews with staff of an integrated congenital heart centre, an initial process map was constructed. A retrospective chart review of patients with isolated surgical atrial septal defect and ventricular septal defect repair from 7/1/2018 through 11/1/2020 informed revisions of the process map. The map was assessed for points of consistency and variability.

Results:

Thirty-two surgical atrial septal defect/ventricular septal defect repair patients were identified. Ten (31%) were reviewed by interventional cardiology before surgical review. Of these, 6(60%) had a failed catheter-based closure and 4 (40%) were deemed inappropriate for catheter-based closure. Thirty (94%) were reviewed in case conference, all attended surgical clinic, and none were admitted prior to surgery. The process map from interviews alone identified surgery rescheduling as a point of major variability; however, chart review revealed this was not as prominent a source of variability as pre-operative interventional cardiology review.

Conclusions:

Significant variation in the pre-operative evaluation and planning process for surgical atrial septal defect/ventricular septal defect patients was identified. If such process variation is widespread through CHD care, it may contribute to variations in outcome and cost previously documented within CHD surgery. Future research will focus on determining whether the variation is warranted or unwarranted, associated health outcomes and cost variation attributed to these variations in care processes.

Keywords

Congenital heart surgerypreoperative careatrial septal defectventricular septal defect
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 1 , January 2024 , pp. 164 - 170
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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