Evaluating the congenital heart assessment tool: a quality improvement project
Liz Smith1, Jo Wray2, Kerry L Gaskin3
1Great Ormond Street Hospital NHS Foundation Trust, LondonWC1N, UK.
Insights
The modified Congenital Heart Assessment Tool (CHATm) effectively supports parents of infants with complex congenital heart disease (CHD) at home. CHATm improves parental understanding, decision-making, and early detection of infant deterioration.
Area of Science:
- Pediatric Cardiology
- Health Informatics
- Quality Improvement Science
Background:
- The Congenital Heart Assessment Tool (CHAT) was developed in 2012 to aid parental preparation for infants with complex congenital heart disease (CHD) before hospital discharge.
- Initial testing focused on acceptability and feasibility in a single center from 2013-2015.
Purpose of the Study:
- To evaluate the broader implementation of the CHAT tool in community settings across four pediatric cardiac centers.
- To assess the effectiveness of a modified tool, CHATm, in supporting home care for infants with complex CHD.
Main Methods:
- A four-center collaborative mixed-methods quality improvement project was conducted from 2016-2018.
- Utilized a Plan-Do-Study-Act (PDSA) cycle, including retrospective case note review, simulation exercises, and clinical implementation of CHATm.
Main Results:
- CHATm simulation proved beneficial for practitioners in identifying potential infant health triggers.
- The tool effectively predicted critical "amber" and "red" triggers, guiding parental actions and professional escalation.
- Parents reported enhanced knowledge, improved decision-making, and better communication with healthcare professionals when using CHATm.
Conclusions:
- Clinical use of CHATm highlighted the need for a structured model to assess parental readiness for home monitoring programs.
- Recommendations include developing a standardized, nationally recognized training program for all CHATm users to ensure effective implementation.
Background:
An early warning tool, the Congenital Heart Assessment Tool (CHAT), was designed in 2012 to support parental preparation before discharge, enhancing understanding of their infant's complex CHD, the signs of deterioration to look out for and to support decision-making at home. Acceptability and feasibility of the tool were tested during 2013-2015 in a single centre.
Aim Of This Project:
To evaluate the wider implementation across four children's cardiac centres of the CHAT for infants with complex CHD in the community setting.
Design:
A four-centre collaborative mixed-methods quality improvement project funded by The Health Foundation, during 2016-2018. A plan, do, study, act cycle of improvement was employed. This article reports on the planning phases, creation of a modified tool (CHATm); and the implementation phases, including retrospective case note review using CHATm; tabletop simulation exercise using CHATm and clinical implementation of CHATm.
Results:
Key findings included the benefit of using CHATm simulation for practitioners; the effectiveness of CHATm in predicting amber and red triggers, indicating parental actions and escalation of concerns to professionals. Parents using CHATm found it enhanced knowledge in preparation for going home, supported decision-making, and discussions with health care professionals.
Conclusion:
Using the CHATm clinically identified the need to develop a structured model of assessment of parental suitability for home-monitoring programmes. A robust and nationally agreed training programme for all staff using CHATm was recommended to ensure successful and complete implementation in practice.
Related Concept Videos
01:15Nursing Evaluation
01:17Assessment of apical pulse
Assessing the apical pulse is a critical nursing procedure, particularly indicated for: