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Referral Order Placement Decreases Time to Transfer to Adult Congenital Heart Disease Care
Debora Burger1, Quin E Denfeld2,3, Patrick D Evers4
1Oregon Health & Science University School of Nursing, 3455 S.W. U.S. Veterans Hospital Road, Portland, OR, 97239-2941, USA. burgerde@ohsu.edu.
Insights
Placing a referral order at the final pediatric cardiology visit significantly improves the rate and timeliness of transfer for pediatric patients with complex congenital heart disease (CHD) to adult congenital heart disease (ACHD) centers.
Area of Science:
- Cardiology
- Pediatric Medicine
- Public Health
Background:
- Coordinated transfer of pediatric patients with moderate to great complexity congenital heart disease (CHD) to adult congenital heart disease (ACHD) centers is crucial for reducing complications.
- Current transfer practices vary, potentially impacting patient outcomes.
- The timing and success of transfers are critical for long-term management of CHD.
Purpose of the Study:
- To investigate the impact of referral order placement at the last pediatric cardiology visit on the time to transfer to an accredited ACHD center.
- To analyze the association between referral order placement and successful transfer outcomes.
- To identify factors influencing the transfer process for pediatric CHD patients.
Main Methods:
- Analysis of data from pediatric patients with moderate and great complexity CHD eligible for transfer to a tertiary center's ACHD program.
- Comparison of transfer outcomes and time-to-transfer between patients with and without a referral order placed at their last pediatric cardiology visit.
- Utilized Cox proportional hazards modeling to assess the impact of referral orders, adjusting for relevant covariates.
Main Results:
- Referral orders were placed at the last pediatric cardiology visit for 32.3% of the 65-patient sample.
- Patients with a referral order had a significantly higher successful transfer rate (95% vs. 25%, p < 0.001).
- Placement of a referral order was significantly associated with a sooner time to transfer (HR 6.0; p < 0.001), after adjusting for age, sex, complexity, and location.
Conclusions:
- Implementing referral orders at the final pediatric cardiology visit may enhance the likelihood and efficiency of transfers to ACHD centers.
- This simple intervention could streamline the transition of care for young adults with complex congenital heart conditions.
- Optimizing transfer processes is essential for ensuring continuity of care and improving long-term health outcomes for CHD survivors.
Abstract:
Pediatric patients with moderate and great complexity congenital heart disease (CHD) may benefit from coordinated transfer to adult congenital heart disease (ACHD) centers to reduce the risk of complications; however, there are a variety of transfer practices. We examined the impact of referral order placement at the last pediatric cardiology visit on time to transfer to an ACHD center. We analyzed data collected from pediatric patients with moderate and great complexity CHD who were eligible to transfer to our tertiary center's accredited ACHD center. We examined transfer outcomes and time-to-transfer between those with a referral order placed at the last pediatric cardiology visit and those without using Cox proportional hazards modeling. The sample (n = 65) was 44.6% female and mean age at study start was 19.5 years (± 2.2). Referral orders were placed for 32.3% of patients at the last pediatric cardiology visit. Those who had a referral order placed at the last visit had significantly higher number of successful transfers to the ACHD center compared to those who did not (95% vs 25%, p < 0.001). In a Cox regression model, placement of a referral order at the last pediatric cardiology visit was associated significantly with a sooner time to transfer (HR 6.0; 95% CI 2.2-16.2, p > 0.001), adjusting for age, sex, complexity, living location, and pediatric cardiology visit location. Placement of a referral order at the last pediatric cardiology visit may improve transfer occurrence and time to transfer to accredited ACHD centers.
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