Rationale and methodology of a collaborative learning project in congenital cardiac care

• Published in: The American heart journal Vol. 174; pp. 129 - 137
• Main Authors: Wolf, Michael J., Lee, Eva K., Nicolson, Susan C., Pearson, Gail D., Witte, Madolin K., Huckaby, Jeryl, Gaies, Michael, Shekerdemian, Lara S., Mahle, William T.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2016; Elsevier Limited
• Subjects: Cardiology; Cardiology - education; Cardiovascular; Child; Clinical outcomes; Collaborative learning; Congenital diseases; Cooperative Behavior; Decision making; Education; Health Services Research - methods; Heart; Heart Defects, Congenital - therapy; Humans; Intensive care; Learning Curve; Mortality; Palliative care; Patient Care Team; Pediatrics; Postoperative period; Surgery; Weaning
• ISSN: 0002-8703; 1097-6744; 1097-6744
• DOI: 10.1016/j.ahj.2016.01.013

Collaborative learning is a technique through which individuals or teams learn together by capitalizing on one another’s knowledge, skills, resources, experience, and ideas. Clinicians providing congenital cardiac care may benefit from collaborative learning given the complexity of the patient population and team approach to patient care. Industrial system engineers first performed broad-based time-motion and process analyses of congenital cardiac care programs at 5 Pediatric Heart Network core centers. Rotating multidisciplinary team site visits to each center were completed to facilitate deep learning and information exchange. Through monthly conference calls and an in-person meeting, we determined that duration of mechanical ventilation following infant cardiac surgery was one key variation that could impact a number of clinical outcomes. This was underscored by one participating center’s practice of early extubation in the majority of its patients. A consensus clinical practice guideline using collaborative learning was developed and implemented by multidisciplinary teams from the same 5 centers. The 1-year prospective initiative was completed in May 2015, and data analysis is under way. Collaborative learning that uses multidisciplinary team site visits and information sharing allows for rapid structured fact-finding and dissemination of expertise among institutions. System modeling and machine learning approaches objectively identify and prioritize focused areas for guideline development. The collaborative learning framework can potentially be applied to other components of congenital cardiac care and provide a complement to randomized clinical trials as a method to rapidly inform and improve the care of children with congenital heart disease.