Background: The importance of registries for collaborative quality improvement has been overlooked in low and middle income countries (LMICs). Aga Khan University Hospital (AKUH) in Pakistan joined the Congenital Cardiac Catheterization Project on Outcomes - Quality Improvement (C3PO-QI) in March, 2017 with the goal of leveraging international collaboration to improve patient care and regional standards. Methods: A knowledge, attitude, and practice (KAP) survey was conducted before and after institutional implementation of C3PO-QI with AKUH catheterization lab staff to assess institutional practices around radiation exposure and identify areas for improvement, which included implementation of pre-procedure case discussions and safety training. Radiation, intervention, and adverse event data was compared between AKUH and the collaborative as a whole. Radiation dose was reported as dose area product and adjusted for weight (DAP/kg). Results were reported in percentages and percentiles. Results: Between 6/1/17 - 11/30/17, 106 cases were performed at AKUH out of the 2963 cases for the collaborative as a whole. AKUH vs C3PO-QI data showed similar demographic characteristics, with the highest percentage of patients in the 1-4 year age group (39% vs 30%). There was a slight overrepresentation of diagnostic cases (42% vs 32%) as compared to interventional (58% vs 68%) at AKUH. Interventional procedures were predominately PDA and ASD device closures (n=19, 15 respectively). Among all cases, radiation dose at AKUH was lower than C3PO-QI. Compared to pre-C3PO-QI, AKUH post-C3PO-QI had an increase in the recording of radiation surrogates in catheterization documentation (0% to 100%) and in the percentage of cases that met the established benchmark of “adequate documentation” (35% vs 70%). There was increased self-reported staff interest during the case after implementation of pre-catheterization discussions (25% vs 75%). Conclusion: Collaboration with C3PO-QI facilitated the standardization of documentation at AKUH, including of radiation data, and resulted in improved case planning and communication among staff. Despite the different case mix, participation in a multicenter initiative has been beneficial for practice at AKUH. Key words: Quality improvement, C3PO-QI, Congenital cardiac catheterization

Figure 1

Impact of the Congenital Cardiac Catheterization Project on Outcomes - Quality Improvement (C3PO-QI) in low and middle income countries (LMICs): A single center experience in Pakistan

Key driver diagram

Figure 1

Impact of the Congenital Cardiac Catheterization Project on Outcomes - Quality Improvement (C3PO-QI) in low and middle income countries (LMICs): A single center experience in Pakistan

Key driver diagram

Figure 2

KAP Survey

Figure 2

KAP Survey