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Development of quality metrics for ambulatory pediatric cardiology: Infection prevention

Jonathan N. Johnson1,2, Cindy S. Barrett3, Wayne H. Franklin4, Eric M. Graham5, Nancy J. Halnon6, Brandy A. Hattendorf7, Catherine D. Krawczeski8, James J. McGovern9, Matthew J. O’Connor10, Amy H. Schultz11, Jeffrey M. Vinocur12, Devyani Chowdhury13, Jeffrey B. Anderson14
1 Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, Minnesota, USA
2 Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
3 Children’s Hospital Colorado, Denver, Colorado, USA
4 Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
5 Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
6 University of California, Los Angeles, Los Angeles, California, USA
7 Division of Cardiology, Department of Pediatrics, University of Southern California, Los Angeles, California, USA
8 Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
9 Asheville Cardiology Associates, Mission Health System, Asheville, North Carolina, USA
10 Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
11 Seattle Children’s Hospital, University of Washington, Seattle, Washington, USA
12 Division of Pediatric Cardiology, Department of Pediatrics, University of Rochester, Rochester, New York, USA
13 Cardiology Care for Children, Lancaster, Pennsylvania, USA
14 Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
* Corresponding Author: Jonathan N. Johnson, MD, FACC, FASE, FAAP, Mayo Clinic, Gonda 6-138SW, First Street SW, Rochester, MN 55905, USA. Email:

Congenital Heart Disease 2017, 12(6), 756-761.


Introduction: In 2012, the American College of Cardiology’s (ACC) Adult Congenital and Pediatric Cardiology Council established a program to develop quality metrics to guide ambulatory practices for pediatric cardiology. The council chose five areas on which to focus their efforts; chest pain, Kawasaki Disease, tetralogy of Fallot, transposition of the great arteries after arterial switch, and infection prevention. Here, we sought to describe the process, evaluation, and results of the Infection Prevention Committee’s metric design process.
Methods: The infection prevention metrics team consisted of 12 members from 11 institutions in North America. The group agreed to work on specific infection prevention topics including antibiotic prophylaxis for endocarditis, rheumatic fever, and asplenia/hyposplenism; influenza vaccination and respiratory syncytial virus prophylaxis (palivizumab); preoperative methods to reduce intraoperative infections; vaccinations after cardiopulmonary bypass; hand hygiene; and testing to identify splenic function in patients with heterotaxy. An extensive literature review was performed. When available, previously published guidelines were used fully in determining metrics.
Results: The committee chose eight metrics to submit to the ACC Quality Metric Expert Panel for review. Ultimately, metrics regarding hand hygiene and influenza vaccination recommendation for patients did not pass the RAND analysis. Both endocarditis prophylaxis metrics and the RSV/ palivizumab metric passed the RAND analysis but fell out during the open comment period. Three metrics passed all analyses, including those for antibiotic prophylaxis in patients with heterotaxy/ asplenia, for influenza vaccination compliance in healthcare personnel, and for adherence to recommended regimens of secondary prevention of rheumatic fever.
Conclusions: The lack of convincing data to guide quality improvement initiatives in pediatric cardiology is widespread, particularly in infection prevention. Despite this, three metrics were able to be developed for use in the ACC’s quality efforts for ambulatory practice.


infection prevention, quality, ambulatory, pediatric cardiology

Cite This Article

Johnson, J. N., Barrett, C. S., Franklin, W. H., Graham, E. M., Halnon, N. J. et al. (2017). Development of quality metrics for ambulatory pediatric cardiology: Infection prevention. Congenital Heart Disease, 12(6), 756–761.

This work is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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