The final reason paediatric Cardiac ICU patients require care prior to discharge to the floor: a single-centre survey

Abstract

Objective: To determine the Final ICU Need in the 24 hours prior to ICU discharge for children with cardiac disease by utilising a single-centre survey. Methods: A cross-sectional survey was utilised to determine Final ICU Need, which was categorised as “Cardiovascular”, “Respiratory”, “Feeding”, “Sedation”, “Systems Issue”, or “Other” for each encounter. Survey responses were obtained from attending physicians who discharged children (≤18 years of age with ICU length of stay >24 hours) from the Cardiac ICU between April 2016 and July 2018. Measurements and results: Survey response rate was 99% (n = 1073), with 667 encounters eligible for analysis. “Cardiovascular” (61%) and “Respiratory” (26%) were the most frequently chosen Final ICU Needs. From a multivariable mixed effects logistic regression model fitted to “Cardiovascular” and “Respiratory”, operations with significantly reduced odds of having “Cardiovascular” Final ICU Need included Glenn palliation (p = 0.003), total anomalous pulmonary venous connection repair (p = 0.024), truncus arteriosus repair (p = 0.044), and vascular ring repair (p < 0.001). Short lengths of stay (<7.9 days) had significantly higher odds of “Cardiovascular” Final ICU Need (p < 0.001). “Cardiovascular” and “Respiratory” Final ICU Needs were also associated with provider and ICU discharge season. Conclusions: Final ICU Need is a novel metric to identify variations in Cardiac ICU utilisation and clinical trajectories. Final ICU Need was significantly influenced by benchmark operation, length of stay, provider, and season. Future applications of Final ICU Need include targeting quality and research initiatives, calibrating provider and family expectations, and identifying provider-level variability in care processes and mental models.

The final hospital need in children discharged from a cardiology acute care unit: a single-centre survey study

“…The wide distribution of Final Hospital Needs reported across neonatal and children admitted for cardiac disease highlights the need for multidisciplinary care if we are to optimise the final portion of the patient's experience. It may be assumed that a "cardiovascular" Final Hospital Need designation would predominate in our studied population, and this was true of the Final ICU Need study, 4 but a "cardiovascular" Final Hospital Need accounted for only 36% of all encounters, and for neonates, "feeding/fluid" issues…”

“…Final Hospital Need categories were defined based on previous reports of aetiologies for hospital readmissions in patients with CHD and according to the authors' discretion. 3,4,[9][10][11] In addition to the Final Hospital Need category, providers can select from a list of common modifiable factors associated with the Final Hospital Need designation (Supplemental Figure 1). Final Hospital Need categories included the following:…”

“…A recent study at our institution evaluated the final reason a patient required care in the cardiac ICU. 4 The Final ICU Need was associated with benchmark operation and length of ICU stay. These data have led to improvement efforts to reduce practice variation and improve clinical processes in that segment of care.…”