CICU Attending Children's Hospital Colorado Centennial, Colorado, United States
Abstract:
Introduction: Children with congenital heart disease (CHD) are at increased risk of neurodevelopmental impairments. The etiology of these impairments is multifactorial with length of surgical hospitalization consistently identified as a primary predictor. Potentially modifiable risk factors associated with hospitalization which could impact neurodevelopment include being left alone for long periods of time with minimal interaction or opportunity to engage in developmentally appropriate play. Volunteers may be an underutilized resource to help providers and families deliver neurodevelopmental care to inpatients with CHD. With this, we aimed to develop a volunteer program specific to our Cardiac Intensive Care (CICU) and Cardiac Progressive Care Units (CPCU) with a goal of volunteers providing targeted developmental care during patient interactions.
Methods: Our Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) interdisciplinary team developed a volunteer program specifically for inpatients with CHD. Volunteers underwent hospital volunteer training as well as CINCO-specific training with Heart Institute’s child life specialists to best equip them in their bedside volunteer roles. This included education about working with cardiac patients and an introduction to the Developmental Plans made by physical, occupational, and speech/language therapists. Developmental Plans include a goal from each discipline based on current skill level, caregiver priorities, and developmental milestones appropriate for patient's age and are used as “therapy extenders” to increase the amount of time children worked on therapy goals, as well as structure the volunteers’ patient interactions. Patients in the CICU and CPCU were identified to be visited by a volunteer if they had therapy and CINCO orders, indicating they were well enough for visitors and activity. Priority was given to those without a parent/caregiver present at bedside and those with longer lengths of stay.
Results: The first volunteer started September 22, 2021. Between then and June 1, 2022, we onboarded 9 volunteers who worked an average of 18 shifts each for a total of 166, 3-hour shifts. In this time, 625 cardiac inpatients received developmental care from a volunteer. During these visits, 277 patients were played with, 178 patients read to, and 274 patients held in the volunteer’s arms. In addition, Developmental Plans were used during 233 visits. Qualitatively, the volunteer program was received positively by inpatient multidisciplinary staff, families, and volunteers.
Discussion: Volunteers can provide targeted neurodevelopmental care to children with CHD who are inpatient, even during periods of critical illness, providing consistent developmental care when parents are unable to do so. Increasing developmental stimulation and interaction may help alleviate some of the ways in which hospitalization is disadvantageous for overall neurodevelopment. Furthermore, allowing parents time away from the bedside could improve their mental health, which may ultimately improve neurodevelopmental outcomes as well. Volunteers specifically trained to work with inpatient cardiac patients can be utilized to help mitigate potentially modifiable risk factors impacting neurodevelopmental outcomes.
