Standardizing care in congenital heart disease: approaches in the catheterization laboratory

The wide range of procedures performed, as well as the infrequency of many procedures, has posed challenges to standardizing care in pediatric cardiac catheterization laboratories. Although the creation of multi-institutional registries has aided in developing benchmarks that will provide the framework for quality improvement efforts, so far formal efforts to standardize care in the field have been limited. The Standardized Clinical Assessment and Management Plan is a quality improvement initiative, designed for use in a relatively heterogeneous patient population with a single underlying diagnosis. This methodology has been used to standardize the indication for interventions in patients with isolated patent ductus arteriosus and congenital aortic stenosis, as well as to standardize intraprocedural decision-making during balloon aortic valvuloplasty procedures. Early experience with Standardized Clinical Assessment and Management Plans has provided an encouraging example of how to meet the goals of reduc...