Article Text

Impact of Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in LMICs
  1. Fatima Ali1,
  2. Mohammad Qasim Mehdi1,
  3. Saleem Akhtar1,
  4. Nadeem Aslam1,
  5. Rashid Abbas2,
  6. Izat Shah2,
  7. Jabbir Abidi2,
  8. Sajid Arthur2,
  9. Zeenat Nizar2,
  10. Andrea Goodmann3,
  11. Lisa Bergersen3,
  12. Babar Hasan1
  1. 1 Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi, Pakistan
  2. 2 Section of Cardiology, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
  3. 3 Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Babar Hasan, Department of Pediatrics and Child Health, The Aga Khan University Hospital, Karachi 74800, Pakistan; babar.hasan{at}


Background The importance of registries for collaborative quality improvement has been overlooked in low/middle-income countries (LMIC). Aga Khan University Hospital (AKUH) in Pakistan joined the Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in March 2017 with the goal of leveraging international collaboration to improve patient care and institutional standards.

Methods The C3PO-QI key driver-based approach was used, with certain modifications, for process re-engineering in AKUH’s congenital cardiac catheterisation laboratory (CCL) to reduce radiation exposure during cardiac catheterisation procedures (the primary outcome of C3PO- QI). Educating staff and standardising procedural documentation were the principal goals of the process re-engineering. Data survey was used to assess staff knowledge, attitude and practice before and after the initiative. Additionally, case demographics and outcomes were compared between AKUH and C3PO-QI centres.

Results There was an increase in appropriate recording of radiation surrogates (0%–100%, p=0.00) and in the percentage of cases that met the established benchmark of ‘Ideal documentation’ (35% vs 95%, p=0.001). There was also an increase in self-reported staff interest during the case (25% vs 75%, p=0.001). AKUH versus C3PO-QI data showed similar demographic characteristics. There was a slight over-representation of diagnostic cases (42% vs 32%) as compared with interventional (58% vs 68%) at AKUH. Furthermore, interventional procedures were predominately PDA and ASD device closures (n=19 and 15, respectively). The frequency of adverse events were the same between AKUH and collaborative sites.

Conclusion Collaborative efforts between developed and LMIC CCL are significant in advancing system-level processes.

  • congenital heart disease
  • paediatric interventional cardiology

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  • Contributors FA and BH have contributed equally to the study concept, designing, data collection, analysis and manuscript writing. MQM contributed to the data collection, data analysis and manuscript writing. SA and NA helped in data analysis and manuscript writing. RA, IS, JA, SA and ZN contributed to data collection and data analysis. AG and LB helped in critical designing and revision of the manuscript. All authors have contributed significantly and agree with the content of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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