Pediatric Acute Care Cardiology Collaborative: Shared Focus on Quality to Improve Outcomes and Family Experiences

Pediatric Acute Care Cardiology Collaborative: Shared Focus on Quality to Improve Outcomes and Family Experiences 1024 575 Katie Brind'Amour, PhD, MS, CHES
Illustration of heart, CAVD

The PAC3 has released three recent studies describing care practices and outcomes across member institutions in an effort to drive improved care.

Established in 2014 with the aim of improving acute care outcomes and experience among pediatric cardiology patients, families, clinicians and hospitals, the Pediatric Acute Care Cardiology Collaborative (PAC3) has started to deliver on its promises in a major way. With three recent publications detailing the variation in acute care practice and outcomes among member institutions, it has paved the way toward well-informed quality improvement endeavors for hospitals of all sizes.

“The biggest takeaway for PAC3 and the biggest success, really, is centers sharing data to improve outcomes for patients and families,” says Stephen Hart, MD, associate medical director for inpatient services at The Heart Center at Nationwide Children’s Hospital and co-chair of the PAC3’s national data committee. “We serve a specific population and it’s hard for any one center to answer a meaningful research question with a small segment of patients. It’s fantastic to have over 40 centers sharing outcomes data and best practices, breaking down barriers that have traditionally existed among competing institutions all focused on improving care for our patients.”

And that’s exactly what the group has done. In their April publication in Pediatric Cardiology, for instance, the group reported on practice variation among participants in PAC3 and the change in high acuity therapy offerings over time. Twenty-six centers completed both a 2017 and 2019 survey on their high acuity therapy offerings.

Not surprisingly, higher volume surgical centers offered more high acuity therapies than their lower volume counterparts. But importantly, the PAC3 found evidence that their collegial education efforts can quickly bear fruit; there was a significant and substantial increase in the number of centers reporting initiation of continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BiPAP) in their acute care units (4 of 26 in 2017 vs 19 of 26 in 2019). Initiation of these therapies and continuous CPAP/BiPAP (which also increased significantly) was a topic discussed in the group’s collaborative learning events in the time between the surveys.

Another of the group’s broad foci has been to reduce length of stay postoperatively. In their study published in The Annals of Thoracic Surgery, the group examined data from the Pediatric Cardiac Critical Care Consortium registry for congenital heart surgery cases from 2014-2018, and found that earlier shifts to the acute care unit (ACU) (from the intensive care unit or ICU) resulted in shorter overall length of stay (LOS) after surgery.

“This highlights how we have to stop thinking about ICU-focused care versus ACU-focused care,” says Dr. Hart. “We have to manage patients across the entire spectrum of their hospitalization and think about their outcomes as one continuum instead of two separate silos.”

The ACU’s general focus on promoting discharge may explain some of this difference in postoperative length of stay. In an effort to identify what else gets kids home sooner, the PAC3 has evaluated the role of advance practice providers (APPs) in pediatric acute care cardiology, and found that higher utilization of APPs was associated with shorter-than-expected postoperative length of stay, as well. The results of this analysis were published in February in Cardiology in the Young.

Dr. Hart believes these papers are just a taste of the insights that the PAC3 can offer the cardiology community.

“There’s the global goal of collaborative learning and quality improvement, as well as a focus on local quality improvement” says Dr. Hart. “For example, we recently had a question about PICC [peripherally inserted central catheter] lines at Nationwide Children’s, and it was easy to look in the PAC3 database to see if we’re an outlier in our use of PICC lines compared to our peer institutions. This type of process helps to identify areas for potential improvement.”

Dr. Hart and his colleague Steven Cassidy, MD, FACC, medical director of the Inpatient Acute Care Cardiology Unit at The Heart Center at Nationwide Children’s and the local PAC3 champion for the hospital, are also excited about the potential of the group’s data registry that started in 2019.

“We have several projects looking at ICU bounce-backs and risks for emergent transfers back to the ICU that will inform quality improvement initiatives at reducing these events,” says Dr. Hart. “And personally, I’m excited about how the collaborative has focused on health equity and discovering new opportunities to improve care for our patients in all areas.”


  1. Hart SA, Tanel RE, Kipps AK, Hoerst AK, Graupe MA, Cassidy SC, Hlavacek AM, Clabby ML, Bush LB, Zhang W, Banerjee MM, Pasquali SK, Gaies M, Madsen N. Intensive care unit and acute care unit length of stay after congenital heart surgery. Ann Thorac Surg. 2020 Oct;110(4):1396-1403.
  2. Willis AJ, Hoerst A, Hart SA, Holbein D, Lowery K, Harahsheh AS, Kipps AK, Madsen N, Patel SS, Tanel RE; Paediatric Acute Care Cardiology Collaborative (PAC3). The added value of the advanced practice provider in paediatric acute care cardiology. Cardiol Young. 2021 Feb;31(2):248-251.
  3. Harahsheh AS, Kipps AK, Hart SA, Cassidy SC, Clabby ML, Hlavacek AM, Hoerst AK, Graupe MA, Madsen NL, Bakar AM, Del Grippo EL, Patel SS, Bost JE, Tanel RE; Pediatric Acute Care Cardiology Collaborative (PAC3). High acuity therapy variation across pediatric acute care cardiology units: Results from the Pediatric Acute Care Cardiology Collaborative Hospital Surveys. Pediatr Cardiol. 2021 Apr 4:1–8.

Image credit: Adobe Stock

About the author

Katherine (Katie) Brind’Amour is a freelance medical and health science writer based in Pennsylvania. She has written about nearly every therapeutic area for patients, doctors and the general public. Dr. Brind’Amour specializes in health literacy and patient education. She completed her BS and MS degrees in Biology at Arizona State University and her PhD in Health Services Management and Policy at The Ohio State University. She is a Certified Health Education Specialist and is interested in health promotion via health programs and the communication of medical information.