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An impact evaluation of a newly developed pediatric cardiac intensive care unit
Michelle Hanna Welander1, Sheila D Keller, LaDonna Northington
1Author Affiliations: Chief Nursing and Clinical Services Officer (Dr Welander), Children's of Mississippi; Associate Professor of Nursing and Senior Director of Research and Evidence-Based Practice (Dr Keller) and Professor of Nursing and Director of Traditional Undergraduate Studies (Dr Northington), School of Nursing, University of Mississippi Medical Center, Jackson.
Insights
A new pediatric cardiac intensive care unit (PCICU) showed no significant difference in most clinical outcomes compared to a general pediatric intensive care unit. However, the PCICU demonstrated improvements in infection rates and length of stay.
Area of Science:
- Pediatric Cardiology
- Intensive Care Medicine
- Healthcare Management
Background:
- Pediatric patients with congenital heart disease (CHD) have complex needs requiring specialized care.
- Interprofessional teamwork is crucial for optimizing outcomes in pediatric cardiac intensive care.
Purpose of the Study:
- To evaluate the impact of a newly established Pediatric Cardiac Intensive Care Unit (PCICU).
- To compare clinical outcomes and nursing resources between a PCICU and a general Pediatric Intensive Care Unit (PICU) for postoperative pediatric cardiac patients.
Main Methods:
- Retrospective pretest/posttest design comparing PCICU and PICU.
- Analysis of demographic data, clinical outcomes, registered nurse (RN) staffing, and RN turnover.
- Utilized Owen's impact evaluation method with t tests and Pearson chi-square tests.
Main Results:
- Demographics were comparable between the PICU (n=296) and PCICU (n=333).
- No significant differences in most clinical outcomes were observed.
- Statistically significant increases in surgeon and RN nursing hours per patient day were found in the PCICU.
- The PCICU experienced a higher RN turnover rate.
Conclusions:
- Most quality measures did not differ statistically between the PCICU and PICU.
- The PCICU showed a noted clinical impact in reducing patient infections, mortality, and ICU length of stay.
- The PCICU evaluation provided leaders with quality indicators and cost impacts of coordinated care.
Purpose:
The highly complex pediatric patients with congenital heart disease require interprofessional teamwork and collaboration to ensure high-quality outcomes with low mortality and morbidity (Congenit Heart Dis. 2013;8:3-19). The purpose of this study was to conduct an impact evaluation for a newly formed pediatric cardiac intensive care unit (PCICU) and to answer: Is there a difference between the pediatric intensive care unit and the PCICU on clinical outcome measures of pediatric cardiac postoperative patients and nursing resources?
Design:
A retrospective pretest/posttest design was used with the independent variables being type of intensive care unit. The confounding variables included demographic data, clinical outcome data, registered nurse (RN) staffing data, and RN turnover data.
Setting:
The setting was a large, level I pediatric medical and surgical intensive care unit (ICU) located at a children's hospital within an academic medical center.
Sample:
The population was pediatric cardiac postoperative patients. Patients excluded were those older than 18 years or cases without a Society of Thoracic Surgeons and European Association for Cardiothoracic Surgery Congenital Heart Surgery Mortality Category score of 1 through 5.
Methods:
Owen's impact evaluation method and descriptive statistical measures, t test and Pearson χ test, were used for analysis.
Results:
Demographic data were comparable between the pediatric intensive care unit (n = 296) and PCICU (n = 333). No statistical differences were found in several of the clinical outcome measures. Statistically significant differences were found in surgeon (P = .00) and RN nursing hours per patient day for all cardiac patients (P = .01). The PCICU time frame had a higher RN turnover rate.
Conclusions:
The majority of quality measures were not statistically different between the 2 ICUs. Even though statistical significance was not reached, the clinical impact of the PCICU's reduction in patient infections, mortality, and ICU length of stay was noted.
Implications:
This evaluation has provided organizational leaders the quality indicators and costs that have been impacted with the addition of interprofessional teamwork and coordination of care through the development of a PCICU.
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