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Implementation of the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) programme: an interdisciplinary,
Kelly R Wolfe1, Sherrill D Caprarola1, Caelah Clark2
1Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
Insights
A new Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) program improved developmental care for children with congenital heart disease (CHD). This low-cost, interdisciplinary initiative demonstrated feasibility and increased implementation over time.
Area of Science:
- Pediatric Cardiology
- Neurodevelopmental Pediatrics
- Healthcare Quality Improvement
Background:
- Children with congenital heart disease (CHD) face risks of neurodevelopmental delays.
- Hospitalization length and environmental factors (sleep, stimulation) negatively impact neurodevelopment in these children.
- There is a need to address modifiable factors within the hospital setting to improve neurodevelopmental outcomes.
Purpose of the Study:
- To create and implement an interdisciplinary inpatient neurodevelopmental care program for children with CHD.
- To address modifiable factors impacting neurodevelopment during hospitalization.
- To improve long-term outcomes for pediatric patients with CHD.
Main Methods:
- A quality improvement study utilizing three plan-do-study-act cycles.
- Co-design of the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) program with multi-level stakeholders, including parents.
- Implementation of interventions such as specialized orders, developmental kits, bedside plans, caregiver education, and a volunteer program.
Main Results:
- The CINCO program was implemented over 18 months, covering 619 admissions.
- Utilization of interventions, particularly medical/nursing orders and caregiver handouts, increased over time.
- A specialized volunteer program rapidly expanded, providing over 500 hours of developmental interaction within six months.
Conclusions:
- A low-cost, systematic program (CINCO) was successfully created and implemented to enhance existing neurodevelopmental care practices.
- The program's feasibility was confirmed by increasing implementation rates.
- Stakeholder buy-in and integration into clinical workflows are crucial for successful implementation.
Background:
Children with CHD are at risk for neurodevelopmental delays, and length of hospitalisation is a predictor of poorer long-term outcomes. Multiple aspects of hospitalisation impact neurodevelopment, including sleep interruptions, limited holding, and reduced developmental stimulation. We aimed to address modifiable factors by creating and implementing an interdisciplinary inpatient neurodevelopmental care programme in our Heart Institute.
Methods:
In this quality improvement study, we developed an empirically supported approach to neurodevelopmental care across the continuum of hospitalisation for patients with CHD using three plan-do-study-act cycles. With input from multi-level stakeholders including parents/caregivers, we co-designed interventions that comprised the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) programme. These included medical/nursing orders for developmental care practices, developmental kits for patients, bedside developmental plans, caregiver education and support, developmental care rounds, and a specialised volunteer programme. We obtained data from the electronic health record for patients aged 0-2 years admitted for at least 7 days to track implementation.
Results:
There were 619 admissions in 18 months. Utilisation of CINCO interventions increased over time, particularly for the medical/nursing orders and caregiver handouts. The volunteer programme launch was delayed but grew rapidly and within six months, provided over 500 hours of developmental interaction with patients.
Conclusions:
We created and implemented a low-cost programme that systematised and expanded upon existing neurodevelopmental care practices in the cardiac inpatient units. Feasibility was demonstrated through increasing implementation rates over time. Key takeaways include the importance of multi-level stakeholder buy-in and embedding processes in existing clinical workflows.
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