OBJECTIVES: Monitoring patient care outcomes is essential to ensure quality of care, hospital performance assessment and identification of areas of deficiency and for evaluation of strategies designed to overcome those weaknesses. We aimed to assess the impact of clinical database development on quality of care in the area of Paediatrics and Congenital Cardiac Surgery.  METHODS: The Cardiothoracic surgery division at the Aga Khan University Hospital maintains a computerized database of all the patients undergoing cardiac surgery since July 2006. For this study, data of 1236 patients operated between July 2006 and Sep 2013 was analyzed. Major measures of outcomes included in-hospital and 30 day mortality and morbidity outcomes like reopening, sepsis prolong ventilation, arrhythmias low cardiac output syndrome. RESULTS: Out of a total of 1236 heart surgeries, the most common open heart surgeries were VSD 27%, TOF 24% were, and 13% were ASD. In closed heart 51% were Modified BT shunts, 17% were PDA. The overall 30-day mortality in open heart was 7.0%, and in closed heart it was 7.3%. Post-surgery more common  complication  in open heart surgery was prolong ventilation which was 39%,arrhythmias 14%,reopenings 11% and sepsis 5%total morbidity was 29% while in closed heart most common complication was prolong ventilation which was 31%, total morbidity was 21%. Readmissions after 30 day of Discharge were 8.4% mainly for respiratory infection. Followed with 85% patients were alive, 0.6% were died at 30 day patients follow up. Changes TOF;early extubation and improving survival. VSD: on table extubation or extubation with 4 hours – minimal morbidity and early discharges.  ASD: on table extubation   CONCLUSIONS: Updated and stringently maintained database helped to identify deficiencies, strength and trends at our hospital and also to design strategies for continuing improvement in patient care. Also provides scientific evidence for comparing results with other institutions of the region and world.