{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T12:59:03Z","timestamp":1781182743299,"version":"3.54.1"},"reference-count":26,"publisher":"Cambridge University Press (CUP)","issue":"6","license":[{"start":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:00:00Z","timestamp":1750809600000},"content-version":"unspecified","delay-in-days":24,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1047951125001969_as1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>\n                      The Pediatric Acute Care Cardiology Collaborative (PAC\n                      <jats:sup>3<\/jats:sup>\n                      ) previously showed decreased postoperative chest tube duration and length of stay in children undergoing 9 Society of Thoracic Surgeons benchmark operations. Here we report how these gains were sustained over time and spread to 8 additional centers within the PAC\n                      <jats:sup>3<\/jats:sup>\n                      network.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1047951125001969_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Patient data were prospectively collected across baseline and intervention phases at the original 9 centres (Pioneer) and 8 new centres (Spread). The Pioneer baseline phase was 6\/2017\u20136\/2018 and Spread was 5\/2019\u20139\/2019. The Pioneer intervention phase was 7\/2018\u20137\/2021 and Spread 10\/2019\u20137\/2021. The primary outcome measure was postoperative chest tube duration in hours, with the aim of 20% overall reduction. Balancing measures included chest tube reinsertion and readmission for pleural effusion. Statistical process control methods and traditional statistics were used to analyse outcomes over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1047951125001969_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 5,042 patients at 17 centres, demographics were comparable. The Pioneer cohort (\n                      <jats:italic>n<\/jats:italic>\n                      = 3,383) sustained a 22.6% reduction in mean chest tube duration (from 91.9 hours to 70.5 hours), while the Spread cohort (\n                      <jats:italic>n<\/jats:italic>\n                      = 1,659) showed a 9.7% reduction (from 73.1 hours to 66.0 hours) in the first 13 months following intervention. Across both cohorts, rates of reinsertion (2.0% versus 2.1%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.869) and readmission for effusion did not change (0.3% versus 0.5%,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.285).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1047951125001969_as4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This multicenter prospective quality improvement study demonstrated sustained reduction in chest tube duration at 9 centres while successfully spreading improvement to 8 additional centres. This project serves as a model for post-operative multicentre quality improvement across a large cohort of congenital cardiac surgery patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1047951125001969","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T00:56:51Z","timestamp":1750813011000},"page":"1154-1160","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Sustaining and spreading success: expanding a multicentre quality improvement project to reduce postoperative chest tube duration after paediatric CHD"],"prefix":"10.1017","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3817-743X","authenticated-orcid":false,"given":"Shreya S.","family":"Sheth","sequence":"first","affiliation":[{"name":"Baylor College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashlin","family":"Tignor","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chloe","family":"Connelly","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas L.","family":"Madsen","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical School"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Graupe","sequence":"additional","affiliation":[{"name":"Cincinnati Children\u2019s Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine E.","family":"Bates","sequence":"additional","affiliation":[{"name":"University of Michigan Medical 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Graupe M, Kipps, A, Sheth, SS, et al. Pediatric Acute Care Cardiology Collaborative. Chest Tube Change Package 2022. https:\/\/pac3quality.org\/wp-content\/uploads\/2021\/11\/PAC3_CTChangePacket_Final20211012.pdf."},{"key":"S1047951125001969_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2011.06.008"},{"key":"S1047951125001969_ref21","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-50"},{"key":"S1047951125001969_ref24","doi-asserted-by":"publisher","DOI":"10.1186\/cc2171"},{"key":"S1047951125001969_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2019.09.078"},{"key":"S1047951125001969_ref9","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.020730"},{"key":"S1047951125001969_ref2","doi-asserted-by":"publisher","DOI":"10.1053\/j.pcsu.2014.01.006"},{"key":"S1047951125001969_ref10","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951118000811"},{"key":"S1047951125001969_ref20","volume-title":"The Improvement Guide: A Practical Approach to Enhancing Organizational Performance","author":"Langley","year":"2009"}],"container-title":["Cardiology in the Young"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1047951125001969","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T12:16:52Z","timestamp":1781180212000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1047951125001969\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":26,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["S1047951125001969"],"URL":"https:\/\/doi.org\/10.1017\/s1047951125001969","relation":{},"ISSN":["1047-9511","1467-1107"],"issn-type":[{"value":"1047-9511","type":"print"},{"value":"1467-1107","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. 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