Quality improvement (QI) programs are key drivers of continual reform in process and patient safety, but at present, there are no pediatric liver transplant (PLT)-specific guidelines validating best practices. As a first step to defining best QI practice, we sought to characterize current QI practices in PLT programs.

METHODS. The Studies for Pediatric Liver Transplant (SPLIT) centers submitted A3 format descriptions of their QI processes including organizational structure, aims, methods, dashboard metrics, projects, and challenges. Centers evaluated their QI program, including areas for development. Program volumes and survival statistics were obtained from 2013 SRTR data. Program A3's were displayed for discussion of best practices at the 2014 SPLIT meeting.

RESULTS. 22 of 30 (73%) SPLIT programs participated, representing 52% of total PLTs performed in 2013. One-year patient survival ranged from 83-100%. Non-participating programs cited “no available staff” or “no formal QI program” as reasons for abstention. Physicians (70%), coordinators (15%), or quality managers (15%) completed the A3. Only 36% of centers identified a QI-trained team member. Common global aims included defining new performance metrics and aligning with hospital QI initiatives. Standard personnel included members from the multidisciplinary PLT team meeting monthly to quarterly. Centers reported to hospital administration annually or semi-annually. QI status was communicated quarterly via presentations and dashboards. There were 49 distinct QI projects conducted. Common challenges included inconsistent team participation, lack of stakeholder commitment, and poor benchmark metrics. The average self-evaluation grade was a B- with “better bi-directional communication, surgeon participation, and project accountability” being the most cited areas for QI.

CONCLUSION. There is considerable variability in the QI infrastructure and process among PLT centers. Leveraging a collaborative multi-center community, like SPLIT, may lead to definition and standardization of PLT QI practices. Sharing QI processes is one strategy to prioritize opportunities to impact the overall quality of PLT.

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