Definitions (adequate vs inadequate) of outcome metrics
| Outcome metrics | Definition of adequate | Definition of inadequate |
| Documentation of radiation surrogates | When all three indicators (FT, air kerma and DAP) were recorded. | When only one or two indicators were recorded. |
| Operator technique | When radiation protocols as low as reasonably achievable (ALARA), along with appropriate use of cine imaging and magnification were used. | High fixed frame rate imaging along with excessive cine imaging or magnification was used. |
| Staff radiation protection | When lead aprons, thyroid collars and correctly positioned dosimeter badges were all used. Quarterly check of dosimetry badges. | When appropriate radiation protective gear was not used or dosimetry badges not regularly checked. |
| Self-interest and knowledge of CCL staff | When the staff demonstrated understanding of case details such as diagnosis, the purpose of the catheterisation, and possible adverse events and their management. Additionally ability to perform accurate haemodynamic calculations. | Lack of knowledge of case diagnosis, purpose of catheterisation and possible adverse event. |
| Catheterisation report documentation | Documentation was considered ideal when all the variables required by the C3PO-QI database were recorded. Documentation was considered adequate if it did not meet the criteria for ideal or inadequate. | In the absence of any of variables (diagnosis, access site, size of devices, stent/balloon details and adverse event details), the documentation was deemed inadequate. |
CCL, cardiac catheterisation laboratory; C3PO-QI, Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement; DAP, dose area product; FT, fluoroscopy time.