Thomas A Miller1, Justin J Elhoff2, Nneka M Alexander3, Samantha C Butler4, Karen C Uzark5, Kristi L Glotzbach6, William T Mahle3, Amy J Lisanti7. 1. University of Utah/Primary Children's Hospital and Maine Medical Center, Portland, ME. 2. Baylor College of Medicine/Texas Children's Hospital, Houston, TX. 3. Children's Healthcare of Atlanta, Atlanta, GA. 4. Boston Children's Hospital, Boston and Harvard Medical School, Boston, MA. 5. University of Michigan/CS Mott Children's Hospital, Ann Arbor, MI. 6. University of Utah/Primary Children's Hospital, Salt Lake City, UT. 7. University of Pennsylvania School of Nursing, Children's Hospital of Philadelphia, Philadelphia, PA.
Abstract
OBJECTIVES: Describe variability in developmental care practices, as documented in the electronic health record, for infants undergoing congenital heart surgery. DESIGN: Multicenter, retrospective, cohort study. SETTING: Six pediatric cardiac centers. PATIENTS: One hundred eighty-two infants undergoing one of three index operations: Norwood palliation, aortic arch reconstruction with ventricular septal defect closure, or arterial switch. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Core domains of developmental care encompassing pain assessment, feeding, infant holding, caregiver involvement, therapy, and psychosocial services were reviewed. Practices varied across individuals, institutions, and the hospital stay. At five of six sites, greater than 90% of individuals had physical or occupational therapy services as part of their care, but the day of first evaluation ranged from day of admission to postoperative day 28. Similar patterns were seen in feeding team and social work involvement. Consistent documentation of developmental care was dependent on the domain and site. Of the total days reviewed (n = 1,192), pain scores were documented in 95%. In those same days, documentation of whether or not a patient was out of the crib to be held varied by site from 11% to 93%. Type of oral feeding, breast versus bottle, was documented on the day prior to discharge 48% of the time. CONCLUSIONS: There are significant, quantifiable variations in documented developmental care practices at both the individual and site level. More reliable documentation of developmental care practices is required to associate these variables with later outcomes and investigate disparities in individualized developmental care practices.
OBJECTIVES: Describe variability in developmental care practices, as documented in the electronic health record, for infants undergoing congenital heart surgery. DESIGN: Multicenter, retrospective, cohort study. SETTING: Six pediatric cardiac centers. PATIENTS: One hundred eighty-two infants undergoing one of three index operations: Norwood palliation, aortic arch reconstruction with ventricular septal defect closure, or arterial switch. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Core domains of developmental care encompassing pain assessment, feeding, infant holding, caregiver involvement, therapy, and psychosocial services were reviewed. Practices varied across individuals, institutions, and the hospital stay. At five of six sites, greater than 90% of individuals had physical or occupational therapy services as part of their care, but the day of first evaluation ranged from day of admission to postoperative day 28. Similar patterns were seen in feeding team and social work involvement. Consistent documentation of developmental care was dependent on the domain and site. Of the total days reviewed (n = 1,192), pain scores were documented in 95%. In those same days, documentation of whether or not a patient was out of the crib to be held varied by site from 11% to 93%. Type of oral feeding, breast versus bottle, was documented on the day prior to discharge 48% of the time. CONCLUSIONS: There are significant, quantifiable variations in documented developmental care practices at both the individual and site level. More reliable documentation of developmental care practices is required to associate these variables with later outcomes and investigate disparities in individualized developmental care practices.
Authors: Bradley S Marino; Erica Sood; Adam R Cassidy; Thomas A Miller; Jacqueline H Sanz; David Bellinger; Jane Newburger; Caren S Goldberg Journal: Cardiol Young Date: 2020-11 Impact factor: 1.093
Authors: Michael Gaies; Sara K Pasquali; Mousumi Banerjee; Justin B Dimick; John D Birkmeyer; Wenying Zhang; Jeffrey A Alten; Nikhil Chanani; David S Cooper; John M Costello; J William Gaynor; Nancy Ghanayem; Jeffrey P Jacobs; John E Mayer; Richard G Ohye; Mark A Scheurer; Steven M Schwartz; Sarah Tabbutt; John R Charpie Journal: J Am Coll Cardiol Date: 2019-12-03 Impact factor: 24.094
Authors: Erica Sood; Wilma M Berends; Jennifer L Butcher; Amy J Lisanti; Barbara Medoff-Cooper; Jayne Singer; Elizabeth Willen; Samantha Butler Journal: Adv Neonatal Care Date: 2016-06 Impact factor: 1.968
Authors: H Als; F H Duffy; G McAnulty; S C Butler; L Lightbody; S Kosta; N I Weisenfeld; R Robertson; R B Parad; S A Ringer; J G Blickman; D Zurakowski; S K Warfield Journal: J Perinatol Date: 2012-02-02 Impact factor: 2.521