ACPC Quality Network Shared Best Practices

This page is available to all Adult Congenital & Pediatric Cardiology Quality Network Sites to share tools, resources, and other quality improvement strategies related to the ACPC Quality Network metrics or quality improvement activities. The purpose of this site is to encourage and allow sharing of quality improvement tools, practices and processes developed by participants to improve care. Facilities and teams are encouraged to provide materials that have evidence supporting their value.

ACC will review and approve the submitted materials. All materials posted to this Shared Best Practices page reflect the views and opinions of the owner, and do not necessarily reflect the views and opinions of the ACC. All materials are posted as provided with no representation or warranty of usability or fitness.

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Shared Practice

Hospital/Facility

Boston Children's Hospital

Clinical Topic - ACPC Quality Network Metrics or Quality Improvement Activity

Elevated BMI (metric #002)
Genetic testing in TOF (metric #020)

Resources, Strategies and Tools Used

We formed multidisciplinary working groups, appointed physician and nurse champions to lead the planning of change strategies, and collaborated with quality improvement specialists, dieticians, parents, experts in the fields of preventive cardiology and cardiac genetics, and information technologists.

Data review was used to drive iterative change and inform intervention strategies. QI efforts began with staff education about the metrics. A patient education sheet was developed around meaning of elevated BMI and suggestions for management; the sheet was made available for distribution to patients and parents in clinic. Nurses and clinical assistants were recruited to improve clinician recognition of patients with elevated BMI and to aid in distribution of educational materials.

Information technology assisted in making BMI percentile an accessible variable for download and electronically linking the patient education sheet to the medical record for ease of access and future referencing. With the help of information technologists, historic genetic labs were made easily visible within the active patient chart. Along with staff education about the metric, cardiac genetics colleagues created a "talking points" handout for providers to aid in the discussion of 22q11.2 deletion testing with patients; the handout was circulated via email and made available in all clinics.

Lastly, a simultaneous initiative was underway among our colleagues in general genetics to create a "genetics narrative" for all patients in their care. The genetics narrative was made available by electronic link to the cardiology documentation system.

Outcome

Counseling for elevated BMI was highly variable with continued opportunity for improvement, although later quarters of performance show an optimistic trend with QI efforts. Improved documentation of genetic testing in TOF was seen simply by enhanced search for historic genetic labs, though chart audit in the latter quarters noted an uptick in clinician discussion of genetic assessment. Some resistance to testing remains for teenage patients in whom the genetic abnormality is not suspected by the clinician, accounting for the plateau in our performance around 85%.

Lessons Learned & Shared Tools

Heart Healthy education sheets and BMI education sheet for patients/families
Genetic testing talking points handout for providers