Standardizing care in congenital heart disease: approaches in the catheterization laboratory

The recognition that practice variation can lead to higher resource utilization and negatively affect the delivery of care [1–3] has led to concerted efforts to standardize care across all subspecialties in medicine. The ultimate goal of this effort is to improve patient safety and clinical outcomes. Examples of standardization tools include clinical practice guidelines, algorithms of care, templated electronic medical records, and surgical checklists [2,4–10]. Unfortunately, for rare conditions, evidence to support ‘best clinical practice’ is often nonexistent, and clinical decision-making can become idiosyncratic [11]. Efforts to standardize care in the pediatric cardiac catheterization laboratory have been limited, and are met with significant challenges inherent to any subspecialty that deals with rare diseases. However, over the past several years, important steps have been taken to start to address these challenges. In this article, we present a review of this experience and the initial efforts to standardize care in the pediatric cardiac catheterization laboratory.