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Association Between Implementation of a Cardiovascular Step-Down Unit and Process-of-Care Outcomes in Patients With

Ronen Zipkin1, Kathleen Ostrom2, Abiola Olowoyeye2

  • 1Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California rzipkin@chla.usc.edu.

Hospital Pediatrics
|May 3, 2015
PubMed

Insights

Implementing a pediatric cardiovascular step-down unit (CVSDU) significantly reduced length of stay and rapid response events for children with congenital heart disease. This change improved care processes without increasing adverse events.

Area of Science:

  • Pediatric Cardiology
  • Healthcare Quality Improvement
  • Hospital Operations

Background:

  • The Joint Commission's safety goals prompted hospitals to improve clinical deterioration response.
  • Intermediate-care units were introduced for non-ICU patients.
  • The impact of pediatric cardiovascular step-down units (CVSDU) on care outcomes was unstudied.

Purpose of the Study:

  • To evaluate the effect of establishing a CVSDU on process-of-care outcomes.
  • To compare outcomes before and after CVSDU implementation in pediatric congenital heart disease patients.

Main Methods:

  • Retrospective cohort study of 1415 pediatric congenital heart disease patients.
  • Compared outcomes 1 year before and 1 year after CVSDU implementation.
  • Used non-cardiac tracheostomy/ventilator-dependent patients as controls (n=606).

Main Results:

  • CVSDU patients had significantly decreased total length of stay (LOS) (7.0 vs 5.4 days) and non-ICU LOS (3.5 vs 3.0 days).
  • Rapid response team/code blue rate per 1000 non-ICU patient days decreased significantly (11.2 vs 7.0).
  • No significant outcome differences were observed in the control group.

Conclusions:

  • Establishing a CVSDU was associated with reduced LOS for pediatric congenital heart disease patients.
  • CVSDU implementation correlated with lower rates of rapid response and code blue events.
  • The changes improved care processes without negative impacts on control patient groups.
Abstract

Keywords:
cardiopulmonary arrestcardiovascular care unithospital stayoutcome measuresrapid response team

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