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Gal DB, Pater CM, McGinty M, Lobes G, Tuemler C, Eldridge PM, Frakes B, Marcuccio E, Hanke SP, Gaies MG. Initiative to increase family presence and participation in daily rounds on a paediatric acute care cardiology unit. Cardiol Young 2024; 34:44-49. [PMID: 37138526 DOI: 10.1017/s1047951123001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Family-centred rounds benefit families and clinicians and improve outcomes in general paediatrics, but are understudied in subspecialty settings. We sought to improve family presence and participation in rounds in a paediatric acute care cardiology unit. METHODS We created operational definitions for family presence, our process measure, and participation, our outcome measure, and gathered baseline data over 4 months of 2021. Our SMART aim was to increase mean family presence from 43 to 75% and mean family participation from 81 to 90% by 30 May, 2022. We tested interventions with iterative plan-do-study-act cycles between 6 January, 2022 and 20 May, 2022, including provider education, calling families not at bedside, and adjustment to rounding presentations. We visualised change over time relative to interventions with statistical control charts. We conducted a high census days subanalysis. Length of stay and time of transfer from the ICU served as balancing measures. RESULTS Mean presence increased from 43 to 83%, demonstrating special cause variation twice. Mean participation increased from 81 to 96%, demonstrating special cause variation once. Mean presence and participation were lower during high census (61 and 93% at project end) but improved with special cause variation. Length of stay and time of transfer remained stable. CONCLUSIONS Through our interventions, family presence and participation in rounds improved without apparent unintended consequences. Family presence and participation may improve family and staff experience and outcomes; future research is warranted to evaluate this. Development of high level of reliability interventions may further improve family presence and participation, particularly on high census days.
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Affiliation(s)
- Dana B Gal
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA
- Division of Cardiology, Heart Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Colleen M Pater
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Mackenzie McGinty
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Greta Lobes
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Christy Tuemler
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Paula M Eldridge
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Brittany Frakes
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Elisa Marcuccio
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Samuel P Hanke
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Michael G Gaies
- The Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
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Pater CM, Wilmot I, Russell JL, Madsen NL. Advanced fellowship training for cardiology fellows in acute care cardiology. Cardiol Young 2023; 33:1383-1386. [PMID: 35975463 DOI: 10.1017/s1047951122002487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Hospitalised children have become more medically complex and increasingly require specialised teams and units properly equipped to care for them. Within paediatric cardiology, this trend, which is well demonstrated by the expansion of cardiology-specific ICUs, has more recently led to the development of acute care cardiology units to deliver team-based and condition-focused inpatient care. These care teams are now led by paediatric cardiologists with particular investment in the acute care cardiology environment. Herein, we describe the foundation and development of an Acute Care Cardiology Advanced Training Fellowship to meet the clinical, scholarly, and leadership training needs of this emerging care environment.
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Affiliation(s)
- Colleen M Pater
- Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ivan Wilmot
- Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jennifer L Russell
- Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Nicolas L Madsen
- Heart Center at Children's Health Dallas, UT Southwestern, Dallas, TX, USA
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Miller MK, Blume ED, Samsel C, Elia E, Brown DW, Morell E. Parent-Provider Communication in Hospitalized Children with Advanced Heart Disease. Pediatr Cardiol 2022; 43:1761-1769. [PMID: 35538320 DOI: 10.1007/s00246-022-02913-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
Communication between parents and providers of children with cardiac disease is essential to parental decision-making. This study explored how parents of hospitalized children with advanced heart disease perceived communication with their child's providers. We performed a prospective survey study of parents and physicians of children with advanced heart disease age 30 days to 19 years admitted to the hospital for > 7 days over a 1-year period at a single institution (n = 160 parent-provider pairs). Descriptive statistics were primarily used and Fisher exact tests and kappa statistics were used to assess agreement. All parents rated communication with their child's care team as excellent, very good, or good, but 56% of parents reported having received conflicting information. Parental perception of "too many" people giving them information was associated with overall poorer communication and less preparedness for decision-making. One-third (32%) of parents felt unprepared for decision-making, despite 88% feeling supported. Parents and physicians showed poor agreement with respect to overall adequacy of communication, receipt of conflicting information, and evaluation of the most effective way for parents to receive information. Interventions involving physician communication training and proactive assessment of parent communication preferences may be beneficial.
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Affiliation(s)
- Mary Katherine Miller
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Chase Samsel
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
| | - Eleni Elia
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - David W Brown
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Emily Morell
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA
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Abstract
OBJECTIVES Advanced practice providers (APPs) are being employed at increasing rates in order to meet new in-hospital care demands. Utilising the Paediatric Acute Care Cardiology Collaborative (PAC3) hospital survey, we evaluated variations in staffing models regarding first-line providers and assessed associations with programme volume, acuity of care, and post-operative length of stay (LOS). STUDY DESIGN The PAC3 hospital survey defined staffing models and resource availability across member institutions. A resource acuity score was derived for each participating acute care cardiology unit. Surgical volume was obtained from The Society of Thoracic Surgeons database. Pearson's correlation coefficients were used to evaluate the relationship between staffing models and centre volume as well as unit acuity. A previously developed case-mix adjustment model for total post-operative LOS was utilised in a multinomial regression model to evaluate the association of APP patient coverage with observed-to-expected post-operative LOS. RESULTS Surveys were completed by 31 (91%) PAC3 centres in 2017. Nearly all centres (94%) employ APPs, with a mean of 1.7 (range 0-5) APPs present on weekday rounds. The number of APPs present has a positive correlation with surgical volume (r = 0.49, p < 0.01) and increased acuity (r = 0.39, p = 0.03). In the multivariate model, as coverage by APPs increased from low to moderate or high, there was greater likelihood of having a shorter-than-expected post-operative LOS (p < 0.001). CONCLUSIONS The incorporation of paediatric acute care cardiology APPs is associated with reduced post-operative LOS. Future studies are necessary to understand how APPs impact these patient-specific outcomes.
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Harahsheh AS, Kipps AK, Hart SA, Cassidy SC, Clabby ML, Hlavacek AM, Hoerst AK, Graupe MA, Madsen NL, Bakar AM, Del Grippo EL, Patel SS, Bost JE, Tanel RE. High Acuity Therapy Variation Across Pediatric Acute Care Cardiology Units: Results from the Pediatric Acute Care Cardiology Collaborative Hospital Surveys. Pediatr Cardiol 2021; 42:1074-1081. [PMID: 33813599 PMCID: PMC8019478 DOI: 10.1007/s00246-021-02584-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/18/2021] [Indexed: 11/30/2022]
Abstract
We utilized the multicenter Pediatric Acute Care Cardiology Collaborative (PAC3) 2017 and 2019 surveys to describe practice variation in therapy availability and changes over a 2-year period. A high acuity therapies (ATs) score was derived (1 point per positive response) from 44 survey questions and scores were compared to center surgical volume. Of 31 centers that completed the 2017 survey, 26 also completed the 2019 survey. Scores ranged from 11 to 34 in 2017 and 11 to 35 in 2019. AT scores in 2019 were not statistically different from 2017 scores (29/44, IQR 27-32.5 vs. 29.5/44, IQR 27-31, p = 0.9). In 2019, more centers reported initiation of continuous positive airway pressure (CPAP) and Bi-level positive airway pressure (BiPAP) in Acute Care Cardiology Unit (ACCU) (19/26 vs. 4/26, p < 0.001) and permitting continuous CPAP/BiPAP (22/26 vs. 14/26, p = 0.034) compared to 2017. Scores in both survey years were significantly higher in the highest surgical volume group compared to the lowest, 33 ± 1.5 versus 25 ± 8.5, p = 0.046 and 32 ± 1.7 versus 23 ± 5.5, p = 0.009, respectively. Variation in therapy within the ACCUs participating in PAC3 presents an opportunity for shared learning across the collaborative. Experience with PAC3 was associated with increasing available respiratory therapies from 2017 to 2019. Whether AT scores impact the quality and outcomes of pediatric acute cardiac care will be the subject of further investigation using a comprehensive registry launched in early 2019.
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Affiliation(s)
- Ashraf S. Harahsheh
- Division of Cardiology, Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine & Health Sciences, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Alaina K. Kipps
- Division of Cardiology, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA USA
| | - Stephen A. Hart
- Division of Cardiology, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH USA
| | - Steven C. Cassidy
- Division of Cardiology, Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH USA
| | - Martha L. Clabby
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA USA
| | - Anthony M. Hlavacek
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC USA
| | - Amanda K. Hoerst
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Margaret A. Graupe
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Nicolas L. Madsen
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,Division of Pediatric Cardiology, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH USA
| | - Adnan M. Bakar
- Division of Critical Care Medicine, Department of Pediatrics, Cohen Children’s Medical Center, New Hyde Park, NY USA
| | - Erica L. Del Grippo
- Nemours Cardiac Center at A.I. duPont Hospital for Children, Wilmington, DE USA
| | - Sonali S. Patel
- Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine, Aurora, CO USA
| | - James E. Bost
- Division of Biostatistics and Study Methodology, Children’s National Hospital, George Washington University School of Medicine, Washington, DC USA
| | - Ronn E. Tanel
- Division of Pediatric Cardiology, Department of Pediatrics, UCSF Benioff Children’s Hospital, UCSF School of Medicine, San Francisco, CA USA
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Hoerst A, Bakar A, Cassidy SC, Clabby M, Grippo ED, Graupe M, Harahsheh AS, Hlavacek AM, Hart SA, Kipps AK, Madsen NL, O’Neil DD, Patel SS, Strohacker CM, Tanel RE. Variation in care practices across pediatric acute care cardiology units: Results of the Pediatric Acute Care Cardiology Collaborative (PAC
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) hospital survey. CONGENIT HEART DIS 2019; 14:419-426. [DOI: 10.1111/chd.12739] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/10/2018] [Accepted: 11/22/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Amanda Hoerst
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio
| | - Adnan Bakar
- Cohen’s Children’s Medical Center, Department of Pediatrics Donald and Barbara Zucker School of Medicine at Hofstra/Northwell New Hyde Park New York
| | - Steven C. Cassidy
- Nationwide Children’s Hospital, Department of Pediatrics The Ohio State University College of Medicine Columbus Ohio
| | - Martha Clabby
- Children’s Healthcare of Atlanta, Department of Pediatrics Emory University School of Medicine Atlanta Georgia
| | - Erica Del Grippo
- Nemours Alfred I. duPont Hospital for Children Wilmington Delaware
| | - Margaret Graupe
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio
| | - Ashraf S. Harahsheh
- Children’s National Medical Center, Department of Pediatrics The George Washington University School of Medicine Washington District of Columbia
| | - Anthony M. Hlavacek
- MUSC Children’s Hospital, Department of Pediatrics Medical University of South Carolina Charleston South Carolina
| | - Stephen A. Hart
- Nationwide Children’s Hospital, Department of Pediatrics The Ohio State University College of Medicine Columbus Ohio
| | - Alaina K. Kipps
- Lucile Packard Children’s Hospital, Department of Pediatrics Stanford University School of Medicine Palo Alto California
| | - Nicolas L. Madsen
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio
| | | | - Sonali S. Patel
- Children’s Hospital Colorado, Department of Pediatrics University of Colorado School of Medicine Aurora Colorado
| | - Courtney M. Strohacker
- C. S. Mott Children’s Hospital, Department of Pediatrics University of Michigan School of Medicine Ann Arbor Michigan
| | - Ronn E. Tanel
- UCSF Benioff Children’s Hospital, Department of Pediatrics UCSF School of Medicine San Francisco California
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