Hancock Friesen Camille L, Lockhart Amy T, O'Blenes Stacy B, Moulton Dagmar T, Finley John P, Warren Andrew E
University of Texas Southwestern, Dallas, Texas, USA.
Children's Health, Dallas, Texas, USA.
CJC Open. 2019 Jun 7;1(5):219-224. doi: 10.1016/j.cjco.2019.05.009. eCollection 2019 Sep.
Relocation, recruitment, or retirement of critical team members may lead to changes in the expertise pool that could threaten patient outcomes in a pediatric heart program. We developed a quality initiative aimed at risk management that uses risk-stratified case complexity and outcomes to guide a program during critical fluxes in the expert staff. The Ramp Down/Up protocol is a systematic, voluntary reduction in the complexity of cases performed, followed by a transparent and intentional escalation of case complexity.
Institutional Ethics Review Board approval for this quality initiative was obtained. Patient/caregiver consent for quality data collection is obtained at the time of hospital admission. Every surgical patient having their index cardiac surgical procedure at the Izaak Walton Killam (IWK) from January 1, 2003, to December 2015 is included. The Ramp Down/Up protocol evolved to have to 4 critical elements: (1) a trigger and a reduction in case complexity; (2) an external/objective expert observer; (3) an escalation in case complexity; and (4) data (qualitative and quantitative) collection and analysis.
The Ramp Down/Up protocol was used 3 times over a 12-year period to address critical expert human resource challenges. The protocol was used for variable duration (3.5-9 months). Patient operative mortality was benchmarked to the Congenital Cardiac Surgery database, and outcomes were stable during and after protocol employment.
A quality initiative aimed at risk management has allowed 1 pediatric heart team to ensure that patient outcomes were maintained during critical human resource changes.
关键团队成员的重新安置、招募或退休可能导致专业人才库的变化，这可能会威胁到儿科心脏项目中的患者治疗结果。我们制定了一项旨在风险管理的质量改进措施，该措施利用风险分层的病例复杂性和治疗结果，在专家团队出现关键变动期间指导项目开展。“逐步递减/递增”方案是一种系统性的、自愿降低所实施病例复杂性的措施，随后是透明且有意地提高病例复杂性。
获得了机构伦理审查委员会对该质量改进措施的批准。在患者入院时获得患者/护理人员对质量数据收集的同意。纳入了2003年1月1日至2015年12月在伊萨克·沃尔顿·基拉姆医院（IWK）接受首次心脏外科手术的每一位外科患者。“逐步递减/递增”方案逐渐发展为包含4个关键要素：（1）触发因素及病例复杂性降低；（2）外部/客观的专家观察员；（3）病例复杂性提高；（4）数据（定性和定量）收集与分析。
在12年期间，“逐步递减/递增”方案使用了3次，以应对关键的专家人力资源挑战。该方案使用的持续时间各不相同（3.5 - 9个月）。患者手术死亡率以先天性心脏外科手术数据库为基准，在方案实施期间及之后结果保持稳定。
一项旨在风险管理的质量改进措施使1个儿科心脏团队能够确保在关键的人力资源变动期间维持患者治疗结果。
