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Digital solution for follow-up in congenital cardiac surgery
Laura Carlson1,2, Jacqueline O'Brien1,2, Nitin Gujral2,3
1Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA.
Insights
An automated system for post-cardiac surgery patient follow-up achieved high response rates. This Discharge Communication (DisCo) system identifies high-risk patients needing closer monitoring after congenital heart surgery.
Area of Science:
- Cardiovascular Surgery
- Health Informatics
- Patient Outcomes
Background:
- Increasing public scrutiny necessitates innovative patient follow-up methods.
- Automated systems are crucial for efficient post-operative care management.
- Effective patient monitoring is vital for improving outcomes after cardiac surgery.
Purpose of the Study:
- To develop and evaluate an automated post-operative follow-up system for cardiac surgery patients.
- To assess the efficacy of a web-based system in collecting patient health status data post-discharge.
- To identify factors associated with adverse outcomes and increased healthcare needs in this population.
Main Methods:
- The Discharge Communication (DisCo) system was implemented, utilizing automated text and email surveys.
- Surveys were sent at 30 days and 1 year post-discharge in English and Spanish, with phone follow-up for non-responders.
- Data collected included patient responses, physician input, and chart reviews, stored in a dedicated database.
Main Results:
- High response rates were achieved: 95% for 30-day surveys and 71% for 1-year surveys.
- Direct patient/family responses via survey links were common (65-78%).
- Factors like cardiac lesion complexity and non-cardiac anomalies correlated with readmission, reintervention, and developmental service needs.
Conclusions:
- The DisCo system effectively assesses the health status of patients post-congenital cardiac surgery.
- This automated approach successfully identifies high-risk patients requiring intensified follow-up.
- The system aids in proactive management and resource allocation for vulnerable patient groups.
Background:
In this era of public scrutiny, there is an ongoing need for innovative methods for patient follow-up.
Objectives:
As part of a quality initiative, we developed an automated post-operative follow-up system for patients following discharge after cardiac surgery at Boston Children's Hospital.
Methods:
Discharge Communication (DisCo) is a web-based system developed at Boston Children's Hospital. An automated text and e-mail with a link to a health status survey are sent at 30 days and 1 year post-discharge in English/Spanish. If there is no response, surveys are completed via phone calls to the patient/patient's physician or chart review. Responses are stored in the DisCo database and the patient's medical record. Patients who underwent cardiac surgery and survived to hospital discharge from October, 2016 received the surveys.
Results:
Overall, 3345 30-day and 2563 1-year surveys were sent between October, 2016 and June, 2020. Of 3345 30-day surveys, there were 3191 responses (95%). Of 2563 1-year surveys, there were 1807 responses (71%). Most patients/families responded directly to the link at 30 days (65% for paediatrics/75% for adults) and at 1 year (72% for paediatrics/78% for adults). Multi-variable logistic regression revealed that higher complexity of cardiac lesion, presence of major non-cardiac anomalies and presence of major residua were associated with readmission and catheter/surgical reinterventions. Non-cardiac anomalies were associated with increased need for services for learning, development or behaviour.
Conclusions:
DisCo provides a successful web-based health status assessment of patients following congenital cardiac surgery. It helps to identify high-risk patients who need closer follow-up.
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