Attending Physician, Director of Acute Care Cardiology, Associate Professor of Pediatrics Ann & Robert H. Lurie Childrens Hospital of Chicago Wilmette, Illinois, United States
Abstract:
Introduction: Traditionally, pediatric cardiac post-operative patients are admitted to the cardiac intensive care unit (CICU). This ensures that these patients receive the appropriate level of care and monitoring from both the front-line provider (FLP) and nursing staff. In our acuity adaptable model of the Regenstein Cardiac Care Unit (CCU) at Ann & Robert H. Lurie Children’s Hospital of Chicago, the same FLPs and nurses care for CICU and step-down (SD) patients. We postulated that we could safely admit patients with certain diagnoses directly to the SD team, where there are 6 dedicated daytime attendings. This would decrease hand-offs between teams, allow families to be cared for by discharge experts, and unburden the CICU team thereby allowing them to care for sicker patients who need their attention.
Methods: Starting in October 2021, we initiated a process where all patients coming from home for secundum atrial septal defect (ASD) or vascular ring repair would be admitted post-operatively to the SD team during business hours. The CICU attending also attended the operating room (OR) hand-off. This list of patients expanded to include new epicardial pacemakers, pectus excavatum, and sinus venosus ASDs that do not require systemic or pulmonary venous manipulation. We tracked admission to SD upon OR hand-off, need for CICU transfer, and on what post-operative day (POD) discharge occurred.
Results: Twenty-three patients with the above diagnoses have been admitted to the CCU. 19 of 23 patients were admitted to SD upon OR hand-off. The 4 patients that were not admitted to SD were admitted to the CICU team after hours and were transferred to SD the next morning. No patient admitted directly to SD required a transfer to the CICU. 87% of patients (20/23) went home by POD 2. Please see the attached figures.
Conclusions: With an acuity adaptable model, where the same FLPs and bedside nurses care for both CICU and SD patients and there is a small group of dedicated SD attendings, some post-operative cardiac surgical patients can be directly admitted to the SD team.
