Pediatric Cardiac Intensive Care Nurse Practitioner Advocate Children's Hospital Burr Ridge, Illinois, United States
Abstract:
Introduction: There is variation in care and hospital length of stay following surgical repair of ventricular septal defects. A reduction in practice variability and use of best practices may improve the quality of post-operative care. The use of clinical pathways in a variety of pediatric care settings have been shown to reduce overall length of stay without increasing the rate of adverse events.
Methods: A fast track clinical pathway was created by an inter-professional team. This pathway was used to guide care following surgical repair of ventricular septal defects. A retrospective review with a historical control was done to compare patients two years prior and three years after the pathway was implemented. Univariate analyses were conducted to compare characteristics in the pre and pathway groups. Linear regression analysis was conducted to model the impact of various independent variables including time to initiation of enteral intake, total ICU length, and total hospital length of stay.
Results: There were 23 pre-pathway patients and 25 pathway patients. Demographic characteristics were similar between groups. Univariate analysis demonstrated a significantly lower time to initiation of enteral intake in the pathway patients (median time to first enteral intake was 360 minutes in pre-pathway patients and 180 minutes in pathway patients, p< 0.01). Multivariate regression analyses demonstrated that the pathway use was independently associated with a decrease in time to first enteral intake (-203 minutes), hospital length of stay (-23.1 hours), and ICU length of stay (-20.5 hours). No adverse events were associated with the use of the pathway, including mortality, reintubation rate, AKI, or increased bleeding from chest tube. No readmissions prior to cardiology follow up.
Conclusions: The use of the clinical pathway improved time to initiation of enteral intake and decreased length of stay. Use of surgery specific pathways may decrease variability in care while also improving quality metrics.
