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Implementation of a novel vocal cord dysfunction management pathway using the consolidated framework for

Greg Merlo1, Jessica M Suna2,3, Amy McIntosh2

  • 1Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia.

Cardiology in the Young
|August 5, 2021
PubMed

Insights

Implementing a new vocal cord dysfunction (VCD) management pathway for children with congenital heart disease in Australia proved feasible. This structured approach aims to safely transition children to oral feeding post-surgery.

Area of Science:

  • Pediatric Surgery
  • Cardiology
  • Speech Pathology
  • Implementation Science

Background:

  • Congenital heart disease (CHD) affects over a thousand Australian children annually, often requiring surgical intervention.
  • Vocal cord dysfunction (VCD) is a significant postoperative complication following CHD surgery, impacting patient outcomes.
  • Multidisciplinary care pathways are crucial for optimizing clinical care and reducing mortality/morbidity in complex pediatric cases.

Purpose of the Study:

  • To implement and evaluate a novel, multidisciplinary management pathway for children experiencing postoperative VCD.
  • To facilitate the safe commencement and transition to oral feeding for pediatric patients with VCD.
  • To assess the feasibility and identify barriers/facilitators to pathway adoption in a clinical setting using the CFIR framework.

Main Methods:

  • An implementation study utilizing the Consolidated Framework for Implementation Research (CFIR).
  • Pathway rollout involved education sessions for clinical stakeholders and adaptations for consent and patient identification.
  • A dedicated team was assigned for ongoing patient monitoring post-recruitment.
  • Implementation success was measured by compliance with the pathway's defined management protocols.

Main Results:

  • Despite several barriers encountered during adoption, the implementation of the VCD management pathway was found to be feasible.
  • Adaptations to the pathway were necessary, particularly in response to the challenges posed by the COVID-19 pandemic.
  • Compliance with pathway-defined management served as the primary metric for evaluating implementation success.

Conclusions:

  • The developed multidisciplinary pathway is a feasible approach for managing postoperative VCD in children undergoing CHD surgery.
  • Pathway adaptations are critical for successful implementation in dynamic healthcare environments, as demonstrated during the COVID-19 pandemic.
  • Continued refinement and adherence to structured pathways can improve the transition to oral feeding and overall patient outcomes.

Keywords:
Implementationcardiac surgeryconsolidated frameworkpaediatricspathwayvocal cord palsy

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