QUALITY ASSURANCE IN PAEDIATRIC CARDIAC CATHETERIZATION: IS VOLUME AN ADEQUATE MARKER?

Background Cardiac catheterization is a cornerstone in the management of congenital heart disease. Therapeutic techniques are rapidly emerging. They are prestigious and highly reimbursed. Few centres are competing about expertise, reputation, and scarce resources. A high volume of procedures is commonly regarded as key qualifying marker. Exposure generates training. However, poorly indicated, poorly performed, and unintended redo procedures increase numbers, too. Objective To assess the validity of this key single marker and to develop an enhanced concept for quality assurance in paediatric catheterization. Proposal We suggest a scoring system that takes into account the 1. number of patients followed; 2. number of referrals from outside; 3. validity of indications; 4. complexity of diseases and procedures; 5. procedure and fluoroscopy time; 6. success rate; 7. frequency and severity of complications; 8. frequency of unintended redo procedures. It requires a 9. standard reporting form for the above data; 10. benchmarking mechanism; 11. automated software algorithm that integrates the reported data and generates the eventual overall score; and 12. a quality evaluation committee that supervises this process. Discussion/Conclusions A minimum number of procedures will assure minimum safety and quality. However, shooting for large numbers may lead to unethical practice. Additional criteria are needed. The above scoring system provides for a profound quality assessment and operator ranking. It guides patients, physicians in training, and resource allocation officials in their choice among centres. And it eventually improves overall service quality.