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The final reason paediatric Cardiac ICU patients require care prior to discharge to the floor: a single-centre survey
Melissa M Winder1, Zhining Ou2, Angela P Presson2,3
1Heart Center, Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Insights
The Final ICU Need for pediatric cardiac patients is often cardiovascular or respiratory. Specific surgeries, shorter stays, and discharge season impact these needs, offering insights for quality improvement.
Area of Science:
- Pediatric Cardiology
- Intensive Care Medicine
- Health Services Research
Background:
- Understanding the final needs of pediatric cardiac patients before Intensive Care Unit (ICU) discharge is crucial for optimizing care.
- Variability in clinical trajectories and ICU resource utilization requires investigation.
Purpose of the Study:
- To define the Final ICU Need in the 24 hours preceding discharge for children with cardiac conditions.
- To identify factors influencing these final needs within a single-center Cardiac ICU.
Main Methods:
- A cross-sectional survey was administered to attending physicians discharging patients from the Cardiac ICU.
- Data were collected for children (≤18 years) with ICU stays >24 hours between April 2016 and July 2018.
- Final ICU Need was categorized into Cardiovascular, Respiratory, Feeding, Sedation, Systems Issue, or Other.
Main Results:
- A 99% survey response rate yielded 667 eligible encounters.
- "Cardiovascular" (61%) and "Respiratory" (26%) were the most common Final ICU Needs.
- Factors influencing Cardiovascular/Respiratory needs included specific surgical procedures, shorter lengths of stay, provider, and season of discharge.
Conclusions:
- Final ICU Need serves as a novel metric for assessing Cardiac ICU utilization and patient clinical pathways.
- Benchmark operations, length of stay, provider, and season significantly influence Final ICU Need.
- This metric can guide quality improvement, research, and management of provider/family expectations.
Objective:
To determine the Final ICU Need in the 24 hours prior to ICU discharge for children with cardiac disease by utilising a single-centre survey.
Methods:
A cross-sectional survey was utilised to determine Final ICU Need, which was categorised as "Cardiovascular", "Respiratory", "Feeding", "Sedation", "Systems Issue", or "Other" for each encounter. Survey responses were obtained from attending physicians who discharged children (≤18 years of age with ICU length of stay >24 hours) from the Cardiac ICU between April 2016 and July 2018.
Measurements And Results:
Survey response rate was 99% (n = 1073), with 667 encounters eligible for analysis. "Cardiovascular" (61%) and "Respiratory" (26%) were the most frequently chosen Final ICU Needs. From a multivariable mixed effects logistic regression model fitted to "Cardiovascular" and "Respiratory", operations with significantly reduced odds of having "Cardiovascular" Final ICU Need included Glenn palliation (p = 0.003), total anomalous pulmonary venous connection repair (p = 0.024), truncus arteriosus repair (p = 0.044), and vascular ring repair (p < 0.001). Short lengths of stay (<7.9 days) had significantly higher odds of "Cardiovascular" Final ICU Need (p < 0.001). "Cardiovascular" and "Respiratory" Final ICU Needs were also associated with provider and ICU discharge season.
Conclusions:
Final ICU Need is a novel metric to identify variations in Cardiac ICU utilisation and clinical trajectories. Final ICU Need was significantly influenced by benchmark operation, length of stay, provider, and season. Future applications of Final ICU Need include targeting quality and research initiatives, calibrating provider and family expectations, and identifying provider-level variability in care processes and mental models.
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