TY - JOUR
T1 - Variation in care practices across pediatric acute care cardiology units
T2 - Results of the Pediatric Acute Care Cardiology Collaborative (PAC3) hospital survey
AU - On behalf of the Pediatric Acute Care Cardiology Collaborative (PAC3)
AU - Hoerst, Amanda
AU - Bakar, Adnan
AU - Cassidy, Steven C.
AU - Clabby, Martha
AU - Grippo, Erica Del
AU - Graupe, Margaret
AU - Harahsheh, Ashraf S.
AU - Hlavacek, Anthony M.
AU - Hart, Stephen A.
AU - Kipps, Alaina K.
AU - Madsen, Nicolas L.
AU - O’Neil, Dora D.
AU - Patel, Sonali S.
AU - Strohacker, Courtney M.
AU - Tanel, Ronn E.
N1 - Publisher Copyright:
© 2019 Wiley Periodicals, Inc.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Background: The Pediatric Acute Care Cardiology Collaborative (PAC3) was established in 2014 to improve the quality, value, and experience of hospital-based cardiac acute care outside of the intensive care unit. An initial PAC3 project was a comprehensive survey to understand unit structure, practices, and resource utilization across the collaborative. This report aims to describe the previously unknown degree of practice variation across member institutions. Methods: A 126-stem question survey was developed with a total of 412 possible response fields across nine domains including demographics, staffing, available resources and therapies, and standard care practices. Five supplemental questions addressed surgical case volume and number of cardiac acute care unit (CACU) admissions. Responses were recorded and stored in Research Electronic Data Capture (REDCap). Results: Surveys were completed by 31 out of 34 centers (91%) with minimal incomplete fields. A majority (61%) of centers have a single dedicated CACU, which is contiguous or adjacent to the intensive care unit in 48%. A nurse staffing ratio of 3:1 is most common (71%) and most (84%) centers employed a resource nurse. Centralized wireless rhythm monitoring is used in 84% of centers with 54% staffed continuously. There was significant variation in the use of noninvasive respiratory support, vasoactive infusions, and ventricular assist devices across the collaborative. Approximately half of the surveyed centers had lesion-specific postoperative pathways and approximately two-thirds had protocols for single-ventricle patients. Conclusions: The PAC3hospital survey is the most comprehensive description of systems and care practices unique to CACUs to date. There exists considerable heterogeneity among unit composition and variation in care practices. These variations may allow for identification of best practices and improved quality of care for patients.
AB - Background: The Pediatric Acute Care Cardiology Collaborative (PAC3) was established in 2014 to improve the quality, value, and experience of hospital-based cardiac acute care outside of the intensive care unit. An initial PAC3 project was a comprehensive survey to understand unit structure, practices, and resource utilization across the collaborative. This report aims to describe the previously unknown degree of practice variation across member institutions. Methods: A 126-stem question survey was developed with a total of 412 possible response fields across nine domains including demographics, staffing, available resources and therapies, and standard care practices. Five supplemental questions addressed surgical case volume and number of cardiac acute care unit (CACU) admissions. Responses were recorded and stored in Research Electronic Data Capture (REDCap). Results: Surveys were completed by 31 out of 34 centers (91%) with minimal incomplete fields. A majority (61%) of centers have a single dedicated CACU, which is contiguous or adjacent to the intensive care unit in 48%. A nurse staffing ratio of 3:1 is most common (71%) and most (84%) centers employed a resource nurse. Centralized wireless rhythm monitoring is used in 84% of centers with 54% staffed continuously. There was significant variation in the use of noninvasive respiratory support, vasoactive infusions, and ventricular assist devices across the collaborative. Approximately half of the surveyed centers had lesion-specific postoperative pathways and approximately two-thirds had protocols for single-ventricle patients. Conclusions: The PAC3hospital survey is the most comprehensive description of systems and care practices unique to CACUs to date. There exists considerable heterogeneity among unit composition and variation in care practices. These variations may allow for identification of best practices and improved quality of care for patients.
KW - cardiovascular care unit
KW - inpatient cardiology
KW - pediatric cardiology
KW - quality improvement
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U2 - 10.1111/chd.12739
DO - 10.1111/chd.12739
M3 - Article
C2 - 31025616
AN - SCOPUS:85059556404
SN - 1747-079X
VL - 14
SP - 419
EP - 426
JO - Congenital Heart Disease
JF - Congenital Heart Disease
IS - 3
ER -