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

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.