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Interstage Outcomes in Infants With Single Ventricle Heart Disease Comparing Home Monitoring Technology to Three-Ring
Michael Bingler1, Lori A Erickson2, Kimberly J Reid2
11 Nemours Children's Hospital Orlando, Orlando, FL, USA.
Insights
The Cardiac High Acuity Monitoring Program (CHAMP) shows promise for improving outcomes in single ventricle infants. This remote monitoring system reduced unplanned intensive care unit days and improved caregiver experience compared to traditional methods.
Area of Science:
- Pediatric Cardiology
- Medical Technology
- Infant Health
Background:
- Single ventricle heart defects present significant challenges for infant interstage outcomes.
- Current remote monitoring methods require improvement for optimal infant care.
- The Cardiac High Acuity Monitoring Program (CHAMP) was developed for enhanced remote monitoring of single ventricle infants.
Purpose of the Study:
- To compare the effectiveness of the CHAMP system against traditional binder monitoring for single ventricle infants.
- To evaluate differences in mortality, resource utilization, and caregiver experience between the two monitoring methods.
- To assess the impact of CHAMP on interstage outcomes and delays in care.
Main Methods:
- A randomized crossover design was employed to compare CHAMP with traditional binder monitoring.
- Single ventricle infants were monitored using binder initially, then randomized to CHAMP at 1 or 2 months post-discharge.
- Caregiver experience was assessed via surveys, and outcomes were tracked over the interstage period.
Main Results:
- No interstage mortality was observed in 31 infants over 4,911 days.
- CHAMP use was linked to fewer unplanned ICU days, shorter delays in care, and reduced resource utilization.
- CHAMP was associated with a lower incidence of interstage growth failure and was preferred by most caregivers.
Conclusions:
- CHAMP demonstrates potential benefits over traditional binder monitoring for single ventricle infants.
- The study suggests improvements in interstage outcomes, care timeliness, and caregiver satisfaction with CHAMP.
- Further multi-center validation in larger populations is recommended to confirm these findings.
Background:
Interstage outcomes for infants with single ventricle remain suboptimal. We have previously described a tablet PC-based platform Cardiac High Acuity Monitoring Program (CHAMP) for remote monitoring which provides immediate access to data, videos, and instant alerts to our single ventricle care team.
Methods:
This study compares traditional three-ring binder monitoring (Binder) to CHAMP using a randomized crossover design to evaluate mortality, resource utilization, and caregiver experience. At discharge, all single ventricle infants were monitored using Binder and randomized to receive CHAMP at either one or two months postdischarge. One month after randomization, caregivers could choose either Binder or CHAMP for the remainder of the interstage period. Caregivers experience was recorded using surveys.
Results:
Enrollment included 31 single ventricle infants from May 2014 to June 2015. There was no interstage mortality over 4,911 total interstage days (median: 144/patient). Of 73 readmissions, 45 were unplanned. Of the initial 23 unplanned readmissions, 13 were found to have been based on data obtained exclusively through CHAMP (as instant alerts or based on data review) rather than caregiver concerns. Due to concerns regarding patient safety, additional enrollment was stopped. The CHAMP use was associated with significantly fewer unplanned intensive care unit days/100 interstage days, shorter delays in care, lower resource utilization at readmissions, and lower incidence of interstage growth failure and was preferred by a majority of caregivers.
Conclusions:
These findings suggest that CHAMP may offer benefits over Binder (improved interstage outcomes, delays in care, and caregiver experience). These findings should be tested across multiple centers in larger populations.
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