Standardization of Care Reduces Length of Stay for Postoperative Congenital Heart Disease Patients. Issue 6 (15th November 2021)

• Record Type: Journal Article
• Authors: Cosgrove, Tara C.; Carlozzi, Lauren N.; Dolan, Kevin F.; Gleeson, Sean P.; Johnson, Lanette L.; Cassidy, Steven C.; Gajarski, Robert J.
• Is Part Of: Pediatric quality & safety. Volume 6:Issue 6(2021)
• Page Start: e493
• Publication Date: 2021-11-15
• Subjects: Pediatric nursing -- Periodicals; Pediatrics -- Periodicals; Patients -- Safety measures -- Periodicals; Children -- Hospital care -- Periodicals; 618.92
• DOI: 10.1097/pq9.0000000000000493
• Languages: English
• ISSNs: 2472-0054

Abstract

Abstract : Supplemental Digital Content is available in the text. Abstract : Introduction: Congenital heart disease (CHD), the most common congenital malformation, often requires surgical correction. As surgical mortality rates are low, a common quality marker linked with surgical outcomes is hospital length of stay (LOS). Reduced LOS is associated with better long-term outcomes, reduced hospital-acquired complications, and improved patient-family satisfaction. This project aimed to reduce aggregate median postoperative LOS for four CHD lesions from a baseline of 6.2 days by 10%. Methods: This single-center study utilized the Institute for Healthcare Improvement model to achieve the project aim. A diuretic wean protocol implemented in April 2018 entailed weaning to a homegoing diuretic regimen upon transfer from the cardiac intensive care unit to the inpatient step-down unit. A discharge milestone checklist implemented in September 2018 contained milestones necessary for discharge and an anticipated date of discharge. Outcome measures included aggregate median postoperative LOS and ∆LOS. Balancing measures included cardiac intensive care unit bounce back, pleural chest tube replacement, and readmission rates. Results: Our baseline aggregate median postoperative LOS for the lesions studied was 6.2 days. Following diuretic protocol implementation, the aggregate median LOS decreased to 4.4 days. Baseline ∆LOS decreased from 5.5 to 0.42 days. Postoperative cost fell by an average of $11, 874. Balancing measures demonstrated no unintended consequences. Conclusions: Implementation of a diuretic wean protocol led to sustained improvement in postoperative LOS, and ∆LOS in a subset of CHD patients with no unintended consequences supporting that standardization of postoperative care is effective for improvement efforts and can reduce overall practice variation.