Related Experiment Video
Updated: Dec 15, 2025
Wireless Telemetry Device Implantation in a Fontan Ovine Model for Continuous and Long-Term Hemodynamic Monitoring
Published on: May 2, 2025
Clinical pathway for the Fontan patient to standardise care and improve outcomes
Sarah M Lagergren1, Megan Jensen1, Bryan Beaven1
1Children's Mercy Hospital, Ward Family Heart Center, Kansas City, MO, USA.
Insights
Implementing a standardized clinical pathway for post-Fontan procedure care significantly reduced hospital length of stay in pediatric patients. This evidence-based approach improved outcomes without compromising patient care quality.
Area of Science:
- Pediatric Cardiology
- Surgical Palliation
- Quality Improvement Science
Background:
- The Fontan procedure is a critical surgical palliation for children with single ventricle anatomy.
- Post-operative management is often variable, leading to prolonged hospital stays.
Purpose of the Study:
- To evaluate if an evidence-based clinical pathway standardizes care and reduces length of stay for post-Fontan patients.
- To assess the impact of a standardized pathway on clinical and financial outcomes.
Main Methods:
- Developed a pathway incorporating components from existing protocols: oxygen use, fluid restriction, diuretic therapy, and central venous access.
- Utilized Plan-Do-Study-Act cycles for pathway trialing and implementation.
- Conducted a retrospective review comparing pre-pathway (2014-2015) and post-pathway (2017-2018) patient outcomes.
Main Results:
- Achieved nearly 100% adherence to the clinical pathway.
- Demonstrated a statistically significant reduction in length of stay from 12 to 9 days (p = 0.007).
- Observed no increase in hospital readmissions post-pathway implementation.
Conclusions:
- Standardizing care through clinical pathways improves clinical and financial outcomes for Fontan patients.
- The implemented pathway enhanced healthcare efficiency without negatively impacting patient care quality.
- This quality improvement initiative offers benefits to healthcare institutions, the industry, and patients.
Introduction:
The Fontan procedure is the final stage of surgical palliation for the children with functionally single ventricle anatomy. The post-operative medical management of this patient population can be variable and hospital length of stay prolonged. The purpose of this quality improvement project was to determine if the implementation of an evidence-based clinical pathway for post-operative management of the Fontan patient at a large Midwestern academic paediatric medical centre would standardise care and decrease length of stay.
Materials And Methods:
The clinical pathway was developed using key components from three published pathways for the Fontan procedure from other paediatric institutions across the United States. Components of the clinical pathway included (1) supplemental oxygen until pleural drainage tubes are removed, (2) fluid restriction to 80% daily maintenance and a prescribed low-fat diet, (3) aggressive and standardised diuretic therapy while inpatient and (4) central venous access. The pathway was trialed using Plan-Do-Study-Act cycles in 2016, implemented in 2017 and sustained in 2018-2019. A retrospective electronic medical record review was performed to compare key outcomes from pre-pathway (2014-2015, 37 patients) with post-pathway implementation (2017-2018, 30 patients).
Results:
Adherence to the pathway was nearly 100% with a statistically significant decrease in length of stay from 12 to 9 days (p = 0.007) and no increase in readmissions.
Conclusion:
Standardising care can improve clinical and financial outcomes for the Fontan patient population without negatively impacting quality of care, thus providing a positive benefit to the healthcare institution, industry and patient.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:17Aortic Regurgitation IV: Nursing Management
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:29Cardiomyopathy V: Interprofessional Care
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:22Heart Failure VI: Adjunct Therapies