Amanda Hoerst1, Adnan Bakar2, Steven C Cassidy3, Martha Clabby4, Erica Del Grippo5, Margaret Graupe1, Ashraf S Harahsheh6, Anthony M Hlavacek7, Stephen A Hart3, Alaina K Kipps8, Nicolas L Madsen1, Dora D O'Neil9, Sonali S Patel10, Courtney M Strohacker11, Ronn E Tanel12. 1. Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio. 2. Cohen's Children's Medical Center, Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York. 3. Nationwide Children's Hospital, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio. 4. Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia. 5. Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware. 6. Children's National Medical Center, Department of Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia. 7. MUSC Children's Hospital, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina. 8. Lucile Packard Children's Hospital, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California. 9. St. Louis Children's Hospital, St. Louis, Missouri. 10. Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado. 11. C. S. Mott Children's Hospital, Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, Michigan. 12. UCSF Benioff Children's Hospital, Department of Pediatrics, UCSF School of Medicine, San Francisco, California.
Abstract
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 PAC3 hospital 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.
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 PAC3 hospital 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.
Authors: Ashraf S Harahsheh; Alaina K Kipps; Stephen A Hart; Steven C Cassidy; Martha L Clabby; Anthony M Hlavacek; Amanda K Hoerst; Margaret A Graupe; Nicolas L Madsen; Adnan M Bakar; Erica L Del Grippo; Sonali S Patel; James E Bost; Ronn E Tanel Journal: Pediatr Cardiol Date: 2021-04-04 Impact factor: 1.655
Authors: Jessica Colyer; Lisa Ring; Sarah Gallagher; Mary Mullenholz; Jan Robison; Kathleen Rigney-Radford; Ashraf S Harahsheh Journal: Pediatr Qual Saf Date: 2022-08-01