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The final reason paediatric Cardiac ICU patients require care prior to discharge to the floor: a single-centre survey

Published online by Cambridge University Press:  23 June 2020

Melissa M. Winder*
Affiliation:
Heart Center, Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
Zhining Ou
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
Angela P. Presson
Affiliation:
Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
Madolin K. Witte
Affiliation:
Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
Adam L. Ware
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
Jennifer Marietta
Affiliation:
Heart Center, Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
J.J. Ward
Affiliation:
University of Utah School of Medicine, Salt Lake City, UT, USA
David K. Bailly
Affiliation:
Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
*
Author for correspondence: Melissa M. Winder, NP, Heart Center, Primary Children’s Hospital, 100 N Mario Capecchi Dr, Salt Lake City, UT84132, USA. Tel: +1 (801) 662-1000; Fax: +1 (801) 662-2469. E-mail: Melissa.winder@imail.org

Abstract

Objective:

To determine the Final ICU Need in the 24 hours prior to ICU discharge for children with cardiac disease by utilising a single-centre survey.

Methods:

A cross-sectional survey was utilised to determine Final ICU Need, which was categorised as “Cardiovascular”, “Respiratory”, “Feeding”, “Sedation”, “Systems Issue”, or “Other” for each encounter. Survey responses were obtained from attending physicians who discharged children (≤18 years of age with ICU length of stay >24 hours) from the Cardiac ICU between April 2016 and July 2018.

Measurements and results:

Survey response rate was 99% (n = 1073), with 667 encounters eligible for analysis. “Cardiovascular” (61%) and “Respiratory” (26%) were the most frequently chosen Final ICU Needs. From a multivariable mixed effects logistic regression model fitted to “Cardiovascular” and “Respiratory”, operations with significantly reduced odds of having “Cardiovascular” Final ICU Need included Glenn palliation (p = 0.003), total anomalous pulmonary venous connection repair (p = 0.024), truncus arteriosus repair (p = 0.044), and vascular ring repair (p < 0.001). Short lengths of stay (<7.9 days) had significantly higher odds of “Cardiovascular” Final ICU Need (p < 0.001). “Cardiovascular” and “Respiratory” Final ICU Needs were also associated with provider and ICU discharge season.

Conclusions:

Final ICU Need is a novel metric to identify variations in Cardiac ICU utilisation and clinical trajectories. Final ICU Need was significantly influenced by benchmark operation, length of stay, provider, and season. Future applications of Final ICU Need include targeting quality and research initiatives, calibrating provider and family expectations, and identifying provider-level variability in care processes and mental models.

Type
Original Article
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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