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Article contents
Reduced length of stay after implementation of a clinical pathway following repair of ventricular septal defect
Published online by Cambridge University Press: 25 May 2023
Abstract
Background:
There is variation in care and hospital length of stay following surgical repair of ventricular septal defects. The use of clinical pathways in a variety of paediatric care settings has been shown to reduce practice variability and overall length of stay without increasing the rate of adverse events.
Methods:
A clinical pathway was created and used to guide care following surgical repair of ventricular septal defects. A retrospective review was done to compare patients two years prior and three years after the pathway was implemented.
Results:
There were 23 pre-pathway patients and 25 pathway patients. Demographic characteristics were similar between groups. Univariate analysis demonstrated a significantly shorter time to initiation of enteral intake in the pathway patients (median time to first enteral intake after cardiac ICU admission 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 cardiac ICU length of stay (–20.5 hours). No adverse events were associated with the use of the pathway, including mortality, reintubation rate, acute kidney injury, increased bleeding from chest tube, or readmissions.
Conclusions:
The use of the clinical pathway improved time to initiation of enteral intake and decreased length of hospital stay. Surgery-specific pathways may decrease variability in care while also improving quality metrics.
Keywords
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2023. Published by Cambridge University Press
References
Lion, KC, Wright, DR, Spencer, S, Zhou, C, Del Beccaro, M, Mangione-Smith, R. Standardized clinical pathways for hospitalized children and outcomes. Pediatrics 2016; 137: 10.1542/peds.2015-1202. DOI 10.1542/peds.2015-1202.CrossRefGoogle ScholarPubMed
Rotter, T, Kinsman, L, James, EL, et al. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev 2010; 2010: CD006632. DOI 10.1002/14651858.CD006632.pub2.Google Scholar
Price, MB, Jones, A, Hawkins, JA, McGough, EC, Lambert, L, Dean, JM. Critical pathways for postoperative care after simple congenital heart surgery. Am J Manag Care 1999; 5: 185–192.Google ScholarPubMed
Pasquali, SK, Jacobs, ML, He, X, et al. Variation in congenital heart surgery costs across hospitals. Pediatrics 2014; 133: 553. DOI 10.1542/peds.2013-2870.CrossRefGoogle ScholarPubMed
Fernandes, AM, Mansur, AJ, Caneo, LF, et al. The reduction in hospital stay and costs in the care of patients with congenital heart diseases undergoing fast-track cardiac surgery. Arq Bras Cardiol 2004; 83: 27–26. DOI 10.1590/s0066-782x2004001300003.Google ScholarPubMed
DeSomma, M, Divekar, A, Galloway, AC, Colvin, SB, Artman, M, Auslender, M. Impact of a clinical pathway on the postoperative care of children undergoing surgical closure of atrial septal defects. Appl Nurs Res 2002; 15: 243–248. DOI 10.1053/apnr.2002.35960.CrossRefGoogle ScholarPubMed
Furlong-Dillard, J, Neary, A, Marietta, J, et al. Evaluating the impact of a feeding protocol in neonates before and after biventricular cardiac surgery. Pediatr Qual Saf 2018; 3: e080. DOI 10.1097/pq9.0000000000000080.10.1097/pq9.0000000000000080CrossRefGoogle ScholarPubMed
Penk, JS, Lefaiver, CA, Brady, CM, Steffensen, CM, Wittmayer, K. Intermittent versus continuous and intermittent medications for pain and sedation after pediatric cardiothoracic surgery; a randomized controlled trial. Crit Care Med 2018; 46: 123–129. DOI 10.1097/CCM.0000000000002771.CrossRefGoogle ScholarPubMed
Bates, KE, Mahle, WT, Bush, L, et al. Variation in implementation and outcomes of early extubation practices after infant cardiac surgery. Ann Thorac Surg 2019; 107: 1434–1440. DOI S0003-4975(18)31828-9.10.1016/j.athoracsur.2018.11.031CrossRefGoogle ScholarPubMed
Lawrence, EJ, Nguyen, K, Morris, SA, et al. Economic and safety implications of introducing fast tracking in congenital heart surgery. Circ Cardiovasc Qual Outcomes 2013; 6: 201–207. DOI 10.1161/CIRCOUTCOMES.111.000066.CrossRefGoogle ScholarPubMed
Bates, KE, Connelly, C, Khadr, L, et al. Successful reduction of postoperative chest tube duration and length of stay after congenital heart surgery: a multicenter collaborative improvement project. J Am Heart Assoc 2021; 10: e020730. DOI 10.1161/JAHA.121.020730.CrossRefGoogle ScholarPubMed
Anderson, BR, Stevens, KN, Nicolson, SC, et al. Contemporary outcomes of surgical ventricular septal defect closure. J Thorac Cardiovasc Surg 2013; 145: 641–647. DOI 10.1016/j.jtcvs.2012.11.032.10.1016/j.jtcvs.2012.11.032CrossRefGoogle ScholarPubMed
Shin, AY, Rao, IJ, Bassett, HK, et al. Target-based care: an intervention to reduce variation in postoperative length of stay. J Pediatr 2021; 228: 208–212.CrossRefGoogle ScholarPubMed