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Noncompliance to a Postoperative Algorithm Using Feeding Readiness Assessments Prolonged Length of Stay at a
Daniel E Ehrmann1, Shaunda Harendt1, Jessica Church1
1Department of Pediatrics, The Heart Institute at Children's Hospital Colorado, Aurora, Colo.; Department of Audiology, Speech Pathology, & Learning Services, Children's Hospital Colorado, Aurora, Colo. Department of Clinical Nutrition, Children's Hospital Colorado, Aurora, Colo.; and Department of Occupational Therapy, Children's Hospital Colorado, Aurora, Colo.
Insights
Noncompliance with postoperative feeding algorithms in pediatric cardiac surgery patients is linked to longer hospital stays. Adhering to objective feeding readiness assessments (FRA) is crucial for optimizing patient outcomes and reducing length of stay (LOS).
Area of Science:
- Pediatric Cardiac Surgery
- Clinical Nutrition
- Healthcare Quality Improvement
Background:
- Variable adherence to postoperative feeding protocols after pediatric cardiac surgery can negatively impact growth, parental satisfaction, and hospital length of stay (LOS).
- A quality improvement initiative audited compliance with a feeding algorithm to identify areas for improvement.
Purpose of the Study:
- To audit compliance with a postoperative feeding algorithm in pediatric cardiac surgery patients.
- To investigate the association between algorithm noncompliance and hospital length of stay (LOS).
Main Methods:
- Retrospective analysis of children (≤ 3 months) undergoing their first cardiac surgery (Jan 2015 - Dec 2016).
- The feeding algorithm utilized objective oral feeding readiness assessments (FRA) to guide decisions on gastrostomy tube (GT) or oral-only feeds.
- Compliance was defined as initiating GT or oral feeds within 3 days of the algorithm's indication.
Main Results:
- Of 69 patients, 71% complied with the algorithm; 65.2% received a gastrostomy tube (GT).
- Noncompliant patients experienced significantly longer LOS (34 vs. 25 days; P=0.01).
- Noncompliant GT recipients waited an average of 6 days longer for tube placement (P≤0.001).
Conclusions:
- This audit revealed significant variability in adherence to the postoperative feeding algorithm, with a tendency towards subjective feeding assessments over objective FRAs.
- Noncompliance with the feeding algorithm was associated with increased hospital LOS, underscoring the need for improved adherence and quality improvement efforts.
Introduction:
Variable compliance to postoperative feeding algorithms after pediatric cardiac surgery may be associated with suboptimal growth, decreased parental satisfaction, and prolonged hospital length of stay (LOS). Our heart center performed an audit of compliance to a previously introduced postoperative feeding algorithm to guide quality improvement efforts. We hypothesized that algorithm noncompliance would be associated with increased LOS.
Methods:
We retrospectively identified children ≤ 3 months admitted for their first cardiac surgery between January 1, 2015 and December 31, 2016. The algorithm uses objective oral feeding readiness assessments (FRA). At the end of a predefined evaluation period, a "sentinel" FRA score is assigned. The sentinel FRA and FRA trend guide decisions to pursue gastrostomy tube (GT) or oral-only feeds. Among those who reached the sentinel FRA, we defined compliance as ≤ 3 days before pursuing GT or oral-only feeds once indicated by the algorithm.
Results:
Sixty-nine patients were included. Forty-nine complied with the algorithm (71%), and 45 received GT (65.2%). Noncompliers had significantly longer LOS (34 versus 25 days; P = 0.01). Among GT recipients, noncompliers waited 6 additional days for a GT compared with compliers (P ≤ 0.001). Subjective decisions to extend oral feeding trials or await results of a swallow study were associated with algorithm noncompliance.
Conclusions:
This audit of compliance to a feeding algorithm after pediatric cardiac surgery highlighted variability of practice, including relying on subjective appraisals of feeding skills over objective FRAs. This variability was associated with increased LOS and can be hypothesis-generating for future quality improvement efforts.
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