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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
An improved congenital heart assessment tool: a quality improvement outcome
Kerry L Gaskin1, Liz Smith2, Jo Wray3
1Department for Midwifery and CPD, School of Nursing and Midwifery, University of Worcester, Henwick Grove, WorcesterWR26AJ, UK.
Insights
The Congenital Heart Assessment Tool (CHATm) effectively helps parents identify infant health deterioration, leading to an improved version (CHAT2). This tool supports decision-making and enhances care for infants with congenital heart defects.
Area of Science:
- Pediatric Cardiology
- Healthcare Quality Improvement
- Patient Safety
Background:
- Congenital heart defects (CHD) are the most common congenital anomaly in England, affecting thousands of newborns annually.
- Despite advances, the early post-operative period and first year of life are critical for infants with severe cardiac defects.
- The Congenital Heart Assessment Tool (CHATm) was developed to improve parental decision-making, care standardization, communication, and safety.
Purpose of the Study:
- To further evaluate the effectiveness and utility of the Congenital Heart Assessment Tool (CHATm).
Main Methods:
- A four-center, mixed-methods quality improvement project conducted over eight phases from 2016-2018.
- This paper reports on phases six (clinical simulation), seven (parent workshop), and eight (tool update).
Main Results:
- Clinical simulation revealed themes of improved documentation, parent and healthcare professional preparation, and enhanced communication.
- Parent workshops highlighted the knowledge gap between parents and professionals regarding congenital heart disease (CHD).
Conclusions:
- The CHATm effectively triggers indicators of infant deterioration, validating parents' ability to recognize changes in their infant's condition.
- Recommendations from the project led to the development of an updated tool, CHAT2, to further enhance care for infants with CHD.
Background:
CHD was the most prevalent congenital anomaly (60.9 per 10,000, 95% CI 59.0-62.8) in England in 2018, with 1767 babies born with severe cardiac defects. The 30-day survival rates for complex procedures continue to improve; however despite care advances, the early post-operative period and first year of life remain a critical time for these infants. The Congenital Heart Assessment Tool was developed to support parental decision-making, standardise care provision, improve communication, and the safety and quality of care.
Aim:
To further evaluate the Congenital Heart Assessment Tool.
Design:
A four centre collaborative mixed-methods quality improvement project funded by The Health Foundation, involving eight phases conducted during 2016-2018. Phases six to eight (clinical simulation exercise, parent workshop, and updated tool) are reported in this paper.
Results:
Four themes emerged from the clinical simulation exercise (phase six) including: improving documentation; preparation of parents; preparation of health care professionals; and communication. One main theme emerged from the parent workshop (phase seven): "what parents know versus what professionals know [about CHD]".
Conclusion:
These phases further validated the effectiveness of the CHATm in terms of triggering amber and red indicators and demonstrated parents' ability to identify deterioration in their infant's clinical condition. Recommendations arising from the quality improvement project enabled the project team to create an updated version of the Congenital Heart Assessment Tool, CHAT2.
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