Variation in Interstage Outpatient Care after the Norwood Procedure: A Report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative

David N. Schidlow, Jeffrey B. Anderson, Thomas S. Klitzner, Robert H. Beekman, Kathy J. Jenkins, John Dale Kugler, Gerard R. Martin, Steven R. Neish, Geoffrey L. Rosenthal, Carole Lannon

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Objective. The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) is the first quality improvement collaborative in pediatric cardiology, and its registry captures information on interstage care and outcomes of infants after the Norwood procedure. The purpose of this study was to evaluate variation in interstage outpatient clinical care practices for infants discharged home after the Norwood procedure. Design. Data for the first 100 infants enrolled in the NPC-QIC registry were evaluated. The care domains assessed for variation included: (1) discharge communication with outpatient cardiologist and primary care physician (PCP); (2) nutrition plan at hospital discharge; and (3) planned use of home surveillance strategies. Results. One hundred infants were discharged home between July 2008 and February 2010, from 21 participating US pediatric cardiac programs. Median age at discharge was 29 (11-188) days. Interstage outpatient care was provided at the Norwood center for 62 infants, at other centers for 25, and at a combination of centers for 13. Complete discharge communication (defined as written communication of medication list, nutrition plan, and red flag checklist) was relayed to only 45 outpatient cardiologists and to 26 PCPs. Nutrition route at discharge was exclusively oral in 49, combined oral and nasogastric (NG)/nasojejunal (NJ) in 38, exclusively NG/NJ in six, combined oral and gastrostomy tube (GT) in six, and exclusively GT in one infant. Home surveillance strategies were utilized for 81 infants (oximetry and weight monitoring in 77, oximetry alone in four), with no home surveillance in 19 infants. Conclusions. Considerable variation exists in interstage outpatient care after the Norwood procedure in the care domains of discharge communication, nutrition, and home surveillance. Standardizing care around evidence-based practices may improve the outcomes for these very high-risk children.

Original languageEnglish (US)
Pages (from-to)98-107
Number of pages10
JournalCongenital Heart Disease
Volume6
Issue number2
DOIs
StatePublished - Mar 1 2011

Fingerprint

Norwood Procedures
Ambulatory Care
Quality Improvement
Heart Diseases
Joints
Cardiology
Communication
Pediatrics
Gastrostomy
Oximetry
Registries
Infant Care
Evidence-Based Practice
Primary Care Physicians
Checklist
Outpatients
Weights and Measures

Keywords

  • Cardiac
  • Congenital Heart Disease
  • Pediatric
  • Quality Improvement

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Variation in Interstage Outpatient Care after the Norwood Procedure : A Report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. / Schidlow, David N.; Anderson, Jeffrey B.; Klitzner, Thomas S.; Beekman, Robert H.; Jenkins, Kathy J.; Kugler, John Dale; Martin, Gerard R.; Neish, Steven R.; Rosenthal, Geoffrey L.; Lannon, Carole.

In: Congenital Heart Disease, Vol. 6, No. 2, 01.03.2011, p. 98-107.

Research output: Contribution to journalArticle

Schidlow, David N. ; Anderson, Jeffrey B. ; Klitzner, Thomas S. ; Beekman, Robert H. ; Jenkins, Kathy J. ; Kugler, John Dale ; Martin, Gerard R. ; Neish, Steven R. ; Rosenthal, Geoffrey L. ; Lannon, Carole. / Variation in Interstage Outpatient Care after the Norwood Procedure : A Report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. In: Congenital Heart Disease. 2011 ; Vol. 6, No. 2. pp. 98-107.
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abstract = "Objective. The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) is the first quality improvement collaborative in pediatric cardiology, and its registry captures information on interstage care and outcomes of infants after the Norwood procedure. The purpose of this study was to evaluate variation in interstage outpatient clinical care practices for infants discharged home after the Norwood procedure. Design. Data for the first 100 infants enrolled in the NPC-QIC registry were evaluated. The care domains assessed for variation included: (1) discharge communication with outpatient cardiologist and primary care physician (PCP); (2) nutrition plan at hospital discharge; and (3) planned use of home surveillance strategies. Results. One hundred infants were discharged home between July 2008 and February 2010, from 21 participating US pediatric cardiac programs. Median age at discharge was 29 (11-188) days. Interstage outpatient care was provided at the Norwood center for 62 infants, at other centers for 25, and at a combination of centers for 13. Complete discharge communication (defined as written communication of medication list, nutrition plan, and red flag checklist) was relayed to only 45 outpatient cardiologists and to 26 PCPs. Nutrition route at discharge was exclusively oral in 49, combined oral and nasogastric (NG)/nasojejunal (NJ) in 38, exclusively NG/NJ in six, combined oral and gastrostomy tube (GT) in six, and exclusively GT in one infant. Home surveillance strategies were utilized for 81 infants (oximetry and weight monitoring in 77, oximetry alone in four), with no home surveillance in 19 infants. Conclusions. Considerable variation exists in interstage outpatient care after the Norwood procedure in the care domains of discharge communication, nutrition, and home surveillance. Standardizing care around evidence-based practices may improve the outcomes for these very high-risk children.",
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