No CrossRef data available.
Article contents
The final hospital need in children discharged from a cardiology acute care unit: a single-centre survey study
Published online by Cambridge University Press: 28 November 2022
Abstract
Objective:
Children with heart disease may require inpatient care for many reasons, but ultimately have a final reason for hospitalisation prior to discharge. Factors influencing length of stay in paediatric cardiac acute care units have been described but the last reason for hospitalisation has not been studied. Our aim was to describe Final Hospital Need as a novel measure, determine Final Hospital Need in our patients, and describe factors associated with this Need.
Methods:
Single-centre survey design. Discharging providers selected a Final Hospital Need from the following categories: cardiovascular, respiratory, feeding/fluid, haematology/ID, pain/sedation, systems issues, and other/wound issues. Univariable and multivariable analyses were performed separately for outcomes “cardiovascular” and “feeding/fluid.”
Measurements and Results:
Survey response rate was 99% (624 encounters). The most frequent Final Hospital Needs were cardiovascular (36%), feeding/fluid (24%) and systems issues (13%). Probability of Final Hospital Need “cardiovascular” decreased as length of stay increased. Multivariate analysis showed Final Hospital Need “cardiovascular” was negatively associated with aortic arch repair, Norwood procedure, and Final ICU Need “respiratory” and “other.” Final Hospital Need "feeding/fluid” was negatively associated with left-sided valve procedure, but positively associated with final ICU need “respiratory,” and tube feeding at discharge.
Conclusions:
Final Hospital Need is a novel measure that can be predicted by clinical factors including age, Final ICU Need, and type of surgery. Final Hospital Need may be utilised to track changes in clinical care over time and as a target for improvement work.
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2022. Published by Cambridge University Press
References
Alexander, PMA, DiOrio, M, Andren, K, et al. Accurate prediction of congenital heart surgical length of stay incorporating a procedure-based categorical variable. Pediatr Crit Care Med. 2018; 19: 949–956.10.1097/PCC.0000000000001668CrossRefGoogle ScholarPubMed
Hart, SA, Tanel, RE, Kipps, AK, et al. Intensive care unit and acute care unit length of stay after congenital heart surgery. Ann Thorac Surg. 2020; 110: 1396–1403.10.1016/j.athoracsur.2020.01.033CrossRefGoogle ScholarPubMed
Optimizing Patient Flow: Moving Patients Smoothly Through Acute Care Settings. IHI Innovation Series white paper, 2003. Boston: Institute for Healthcare Improvement. Available at: www.IHI.org.Google Scholar
Winder, MM, Ou, Z, Presson, AP, et al. The final reason paediatric cardiac ICU patients require care prior to discharge to the floor: a single-centre survey. Cardiol Young..Google Scholar
Hummel, K, White, BR, Algaze, CA, et al. Bedside benchmarks: transparent data to reduce variation in postoperative care. NEJM Catalyst 2021; 2.10.1056/CAT.21.0032CrossRefGoogle Scholar
Gaies, M, Cooper, DS, Tabbutt, S, et al. Collaborative quality improvement in the cardiac intensive care unit: development of the Paediatric Cardiac Critical Care Consortium (PC4). Cardiol Young. 2015; 25: 951–957.10.1017/S1047951114001450CrossRefGoogle ScholarPubMed
Mayer, JE, Hill, K, Jacobs, JP, Overman, DM, Kumar, SR. The society of thoracic surgeons congenital heart surgery database: 2020 update on outcomes and research. Ann Thorac Surg. 2020; 110: 1809–1818.10.1016/j.athoracsur.2020.10.004CrossRefGoogle Scholar
Franklin, RCG, Jacobs, JP, Krogmann, ON, et al. Nomenclature for congenital and paediatric cardiac disease: historical perspectives and The International Pediatric and Congenital Cardiac Code. Cardiol Young 2008; 18 Suppl. 2: 70–80.10.1017/S1047951108002795CrossRefGoogle Scholar
Madsen, NL, Porter, A, Cable, R, et al. Improving discharge efficiency and charge containment on a pediatric acute care cardiology unit. Pediatrics 2021; 148: e2020004663.10.1542/peds.2020-004663CrossRefGoogle ScholarPubMed
Connor, JA, Gauvreau, K, Jenkins, KJ. Factors associated with increased resource utilization for congenital heart disease. Pediatrics. 2005; 116: 689–695.10.1542/peds.2004-2071CrossRefGoogle ScholarPubMed
Manzano-Santaella, A. From bed-blocking to delayed discharges: precursors and interpretations of a contested concept. Health Serv Manage Res. 2010; 23: 121–127.10.1258/hsmr.2009.009026CrossRefGoogle ScholarPubMed
James, G, Witten, D, Hastie, T, Tibshirani, R. An Introduction to Statistical Learning: With Applications in R. Springer, New York, NY, 2014.Google Scholar
Kogon, BE, Ramaswamy, V, Todd, K, et al. Feeding difficulty in newborns following congenital heart surgery. Congenit Heart Dis. 2007; 2: 332–337.10.1111/j.1747-0803.2007.00121.xCrossRefGoogle ScholarPubMed
McKean, EB, Kasparian, NA, Batra, S, Sholler, GF, Winlaw, DS, Dalby-Payne, J. Feeding difficulties in neonates following cardiac surgery: determinants of prolonged feeding-tube use. Cardiol Young. 2017; 27: 1203–1211.10.1017/S1047951116002845CrossRefGoogle ScholarPubMed
Gaies, M, Werho, DK, Zhang, W, et al. Duration of postoperative mechanical ventilation as a quality metric for pediatric cardiac surgery. Ann Thorac Surg. 2018; 105: 615–621.10.1016/j.athoracsur.2017.06.027CrossRefGoogle Scholar
Wright, TE. A novel nesting protocol to decrease readmission and increase patient satisfaction following congenital heart surgery. J Pediatr Nurs. 2018; 43: 1–8.10.1016/j.pedn.2018.07.009CrossRefGoogle ScholarPubMed
Vigna, K, Balakas, K, Steurer, LM, Ercole, PM. Improving the discharge to home experience for pediatric heart center patients and families. J Pediatr Nurs. 2018; 41: 42–47.10.1016/j.pedn.2018.01.004CrossRefGoogle ScholarPubMed
Meo, N, Liao, JM, Reddy, A. Hospitalized after medical readiness for discharge: a multidisciplinary quality improvement initiative to identify discharge barriers in general medicine patients. Am J Med Qual. 2020; 35: 23–28.10.1177/1062860619846559CrossRefGoogle ScholarPubMed
Marino, LV, Johnson, MJ, Hall, NJ, et al. The development of a consensus-based nutritional pathway for infants with CHD before surgery using a modified Delphi process. Cardiol Young. 2018; 28: 938–948.10.1017/S1047951118000549CrossRefGoogle ScholarPubMed
Sables-Baus, S, Kaufman, J, Cook, P, da Cruz, EM. Oral feeding outcomes in neonates with congenital cardiac disease undergoing cardiac surgery. Cardiol Young. 2012; 22: 42–48.10.1017/S1047951111000850CrossRefGoogle ScholarPubMed
Ware et al. supplementary material
Figure S1
File
16.6 KB
Ware et al. supplementary material
Table S1
File
18.3 KB