The final hospital need in children discharged from a cardiology acute care unit: a single-centre survey study

Area of Science:

• Pediatric Cardiology
• Healthcare Quality Improvement
• Clinical Informatics

Background:

• Children with heart disease often have complex hospitalizations with multiple reasons for care.
• While factors influencing length of stay are known, the primary reason for hospitalization before discharge has not been well-defined.
• A novel measure, Final Hospital Need, was introduced to categorize the principal reason for a child's acute care hospitalization.

Purpose of the Study:

• To introduce and define Final Hospital Need as a novel metric in pediatric cardiac acute care.
• To determine the prevalence of different Final Hospital Needs in a cohort of pediatric cardiac patients.
• To identify clinical factors associated with specific Final Hospital Needs.

Main Methods:

• A single-center survey design was employed, with discharging providers categorizing the Final Hospital Need.
• Categories included cardiovascular, respiratory, feeding/fluid, haematology/infectious disease, pain/sedation, systems issues, and other/wound issues.
• Univariable and multivariable analyses were conducted to identify predictors for cardiovascular and feeding/fluid needs.

Main Results:

• The survey achieved a 99% response rate (624 encounters).
• The most common Final Hospital Needs were cardiovascular (36%), feeding/fluid (24%), and systems issues (13%).
• Cardiovascular need decreased with longer length of stay and was associated with specific surgical procedures (aortic arch repair, Norwood) and other ICU needs; feeding/fluid need was associated with specific valve procedures, respiratory ICU needs, and tube feeding.

Conclusions:

• Final Hospital Need is a novel, predictable measure in pediatric cardiac acute care.
• Clinical factors such as age, prior Intensive Care Unit (ICU) need, and surgical type can predict Final Hospital Need.
• This metric offers potential for tracking clinical care evolution and targeting quality improvement initiatives.