Collaborative Systems Analytics: Establishing Effective Clinical Practice Guidelines for Advancing Congenital Cardiac Care
Congenital heart defects (CHDs) are the most common birth defect, occurring in around 1% of births. They are the most common cause of infant deaths due to birth defects, and survivors often face health issues into adulthood. Yet research on procedures to correct pediatric heart conditions is challenging to conduct. Barriers include small samples and unique and complex cases in any one center, clinical practice variance, and the lack of supporting national coordination.
This project showcases the transformation that can happen when operations research (O.R.) is applied to improve the outcome of CHD surgeries in a coordinated effort involving multiple pediatric heart hospitals. Working with the Pediatric Heart Network (PHN), our operations researchers devised a customizable model and decision support framework that couple systems modeling, simulation-optimization decision analytics, clustering and machine learning within a collaborative learning paradigm to help hospitals pinpoint key factors on
practice variance, and to design clinical practice guidelines (CPG) for rapid implementation to improve the outcome of CHD surgeries.
Implementing an early extubation CPG (removal of the breathing apparatus) in five large pediatric heart hospitals, all sites experienced post-implementation beneficial results including an increase in early extubation rates from 12% to 67%, and a decrease in median duration of postoperative intubation from 21.2 hours to 4.5 hours. There was also a trend toward shorter length of stay (LOS) in intensive care unit (from 71.6 hours to 54.2 hours). Overall, the five hospital sites experienced LOS reductions ranging from 12% to 35%, decreased time to oral feeds (37%), and an earlier discontinuation of IV analgesics (37% to 55% depending on drug types). The CPG has since become routine practice.
Earlier resumption of normal feeding and reduction in analgesics usage lessen risks of complications. Less analgesics reduces risks of cognitive impairment and impaired brain
development in children; and shorter mechanical ventilation time and LOS for patients reduces exposure to critical care therapies and indwelling devices, which subsequently reduces the risk of hospital-acquired infections.
The implementation resulted in roughly 27% cost savings, amounting to $13,500 per surgical procedure, on average. It reduced clinical care cost by 65%, pharmacy costs by 46%, laboratory costs by 44%, and imaging costs by 32%. Each year, approximately 40,000 babies are born in the United States with a CHD, many of whom require multiple surgical procedures. Hence, our work translates to more than 540 million U.S. dollars on procedural savings alone.
This unique collaboration offers exciting scientific and medical advances that are far-reaching and immensely impactful to the quality of life of pediatric heart patients and their families. The generalizability of our analytic-collaborative framework and the extraordinary diverse team of stakeholders magnifies its dissemination potential to other pediatric hospitals and to conditions beyond congenital heart disease since intubation is required in many surgical procedures.
The Pediatric Heart Network is competing with Georgia Tech as a 2018 Edelman Finalist, to see other finalists, click here.
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