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A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn

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Developmental Care Practice and Documentation Variability in the Cardiac ICU.

Thomas A Miller¹, Justin J Elhoff², Nneka M Alexander³

¹University of Utah/Primary Children's Hospital and Maine Medical Center, Portland, ME.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

|January 4, 2022

Summary

Developmental care practices for infants after heart surgery show significant variability across healthcare providers and institutions. Improved documentation is needed to understand and address these differences in care.

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Area of Science:

Pediatric cardiac surgery
Neonatal developmental care
Healthcare quality improvement

Background:

Developmental care is crucial for infants undergoing complex procedures like congenital heart surgery.
Variability in care delivery can impact patient outcomes and create disparities.

Purpose of the Study:

To describe the variability in documented developmental care practices for infants undergoing congenital heart surgery.
To identify differences in care across individual providers and institutions.

Main Methods:

Multicenter, retrospective cohort study involving six pediatric cardiac centers.
Reviewed electronic health records of 182 infants undergoing specific congenital heart surgeries.
Assessed core domains of developmental care: pain, feeding, infant holding, caregiver involvement, therapy, and psychosocial services.

Main Results:

Significant variations in developmental care practices were observed across individuals, institutions, and hospital stays.
Documentation consistency varied by care domain and site; for example, out-of-crib holding documentation ranged from 11% to 93%.
Pain scores were documented in 95% of reviewed days, but feeding documentation was less consistent.

Conclusions:

Quantifiable variations in documented developmental care exist at both individual and site levels.
Enhanced and standardized documentation is necessary to link care practices with outcomes and investigate disparities.