{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T19:31:03Z","timestamp":1791487863223,"version":"4.3.4"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,11,2]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Congenital heart disease practices and outcomes vary significantly across centers, including postoperative chest tube (CT) management, which may impact postoperative length of stay (LOS). We used collaborative learning methods to determine whether centers could adapt and safely implement best practices for CT management, resulting in reduced postoperative CT duration and LOS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Nine pediatric heart centers partnered together through 2 learning networks. Patients undergoing 1 of 9 benchmark congenital heart operations were included. Baseline data were collected from June 2017 to June 2018, and intervention\u2010phase data were collected from July 2018 to December 2019. Collaborative learning methods included review of best practices from a model center, regular data feedback, and quality improvement coaching. Center teams adapted CT removal practices (eg, timing, volume criteria) from the model center to their local resources, practices, and setting. Postoperative CT duration in hours and LOS in days were analyzed using statistical process control methodology. Overall, 2309 patients were included. Patient characteristics did not differ between the study and intervention phases. Statistical process control analysis showed an aggregate 15.6% decrease in geometric mean CT duration (72.6\u00a0hours at baseline to 61.3\u00a0hours during intervention) and a 9.8% reduction in geometric mean LOS (9.2\u00a0days at baseline to 8.3\u00a0days during intervention). Adverse events did not increase when comparing the baseline and intervention phases: CT replacement (1.8% versus 2.0%,\n                      <jats:italic>P<\/jats:italic>\n                      =0.56) and readmission for pleural effusion (0.4% versus 0.5%,\n                      <jats:italic>P<\/jats:italic>\n                      =0.29).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">We successfully lowered postoperative CT duration and observed an associated reduction in LOS across 9 centers using collaborative learning methodology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.121.020730","type":"journal-article","created":{"date-parts":[[2021,10,29]],"date-time":"2021-10-29T05:06:51Z","timestamp":1635484011000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Successful Reduction of Postoperative Chest Tube Duration and Length of Stay After Congenital Heart Surgery: A Multicenter Collaborative Improvement Project"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2844-7520","authenticated-orcid":false,"given":"Katherine E.","family":"Bates","sequence":"first","affiliation":[{"name":"Congenital Heart Center University of Michigan C.S. Mott Children's Hospital Ann Arbor MI"},{"name":"Department of Pediatrics University of Michigan Medical School Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chloe","family":"Connelly","sequence":"additional","affiliation":[{"name":"Anderson Center Cincinnati Children\u2019s Hospital Medical Center Cincinnati OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Khadr","sequence":"additional","affiliation":[{"name":"Congenital Heart Center University of Michigan C.S. Mott Children's Hospital Ann Arbor MI"},{"name":"Department of Pediatrics University of Michigan Medical School Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Graupe","sequence":"additional","affiliation":[{"name":"The Heart Institute Cincinnati Children\u2019s Hospital Medical Center Cincinnati OH"},{"name":"Department of Pediatrics University of Cincinnati School of Medicine Cincinnati OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8281-1522","authenticated-orcid":false,"given":"Anthony M.","family":"Hlavacek","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Children\u2019s Heart Center Medical University of South Carolina Children\u2019s Health Charleston SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evonne","family":"Morell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Heart Institute University of Pittsburgh Medical Center Children's Hospital of Pittsburgh Pittsburgh PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3114-2680","authenticated-orcid":false,"given":"Sara K.","family":"Pasquali","sequence":"additional","affiliation":[{"name":"Congenital Heart Center University of Michigan C.S. Mott Children's Hospital Ann Arbor MI"},{"name":"Department of Pediatrics University of Michigan Medical School Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Russell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Labatt Family Heart Centre The Hospital for Sick Children Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan K.","family":"Schachtner","sequence":"additional","affiliation":[{"name":"Cardiac Center The Children\u2019s Hospital of Philadelphia Philadelphia PA"},{"name":"Department of Pediatrics Perelman School of MedicineUniversity of Pennsylvania Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney","family":"Strohacker","sequence":"additional","affiliation":[{"name":"Congenital Heart Center University of Michigan C.S. Mott Children's Hospital Ann Arbor MI"},{"name":"Department of Pediatrics University of Michigan Medical School Ann Arbor MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7747-1201","authenticated-orcid":false,"given":"Ronn E.","family":"Tanel","sequence":"additional","affiliation":[{"name":"Pediatric Heart Center UCSF Benioff Children\u2019s Hospital San Francisco CA"},{"name":"Department of Pediatrics UCSF School of Medicine San Francisco CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3990-5734","authenticated-orcid":false,"given":"Adam L.","family":"Ware","sequence":"additional","affiliation":[{"name":"Department of Pediatrics The Heart Center Primary Children\u2019s Hospital Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharyl","family":"Wooton","sequence":"additional","affiliation":[{"name":"Anderson Center Cincinnati Children\u2019s Hospital Medical Center Cincinnati OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas L.","family":"Madsen","sequence":"additional","affiliation":[{"name":"The Heart Institute Cincinnati Children\u2019s Hospital Medical Center Cincinnati OH"},{"name":"Department of Pediatrics University of Cincinnati School of Medicine Cincinnati OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7782-9472","authenticated-orcid":false,"given":"Alaina K.","family":"Kipps","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Betty Irene Moore Children's Heart CenterLucile Packard Children\u2019s Hospital at StanfordStanford School of Medicine Palo Alto CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6602a1"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000800"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2019.09.078"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03530350023029"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-0803.2009.00328.x"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000000918"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951118000811"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951114001450"},{"key":"e_1_3_2_10_2","first-page":"111","article-title":"Cardiac Networks United: an integrated paediatric and congenital cardiovascular research and improvement network","volume":"18","author":"Gaies M","year":"2018","unstructured":"Gaies M, Anderson J, Kipps A, Lorts A, Madsen N, Marino B, Costello JM, Brown D, Jacobs JP, Kasnic D, et al. 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Boston: Institute for Healthcare Improvement; 2003. Available at: http:\/\/www.IHI.org. Accessed October 10 2021."},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-50"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.11.031"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.09.024"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.121.020730","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T07:56:45Z","timestamp":1715587005000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.121.020730"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,2]]},"references-count":25,"journal-issue":{"issue":"21","published-print":{"date-parts":[[2021,11,2]]}},"alternative-id":["10.1161\/JAHA.121.020730"],"URL":"https:\/\/doi.org\/10.1161\/jaha.121.020730","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,2]]},"assertion":[{"value":"2021-06-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-10-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e020730"}}