Optimizing care of adults with congenital heart disease in a pediatric cardiovascular ICU using electronic clinical decision support*.

Autor:	May LJ; 1Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, CA. 2Division of General Pediatrics, Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, CA. 3Division of Systems Medicine, Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, CA. 4Division of Pediatric Critical Care, Department of Pediatrics, Stanford University, Lucile Packard Children's Hospital, Palo Alto, CA. 5Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, CA., Longhurst CA, Pageler NM, Wood MS, Sharek PJ, Zebrack CM
Jazyk:	angličtina
Zdroj:	Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies [Pediatr Crit Care Med] 2014 Jun; Vol. 15 (5), pp. 428-34.
DOI:	10.1097/PCC.0000000000000124
Abstrakt:	Objectives: The optimal location for postoperative cardiac care of adults with congenital heart disease is controversial. Some congenital heart surgeons operate on these adults in children's hospitals with postoperative care provided by pediatric critical care teams who may be unfamiliar with adult national performance measures. This study tested the hypothesis that Clinical Decision Support tools integrated into the clinical workflow would facilitate improved compliance with The Joint Commission Surgical Care Improvement Project performance measures in adults recovering from cardiac surgery in a children's hospital. Design: Retrospective chart review comparing compliance pre- and post-Clinical Decision Support intervention for Surgical Care Improvement Project measures addressed in the critical care unit: appropriate cessation of prophylactic antibiotics; controlled blood glucose; urinary catheter removal; and reinitiation of preoperative β-blocker when indicated. Setting: Cardiovascular ICU in a quaternary care freestanding children's hospital. Patients: The cohort included 114 adults 18-70 years old recovering from cardiac surgery in our pediatric cardiovascular ICU. Interventions: Clinical Decision Support tools including data-triggered alerts, smart documentation forms, and order sets with conditional logic were integrated into the workflow. Measurements and Main Results: Compliance with antibiotic discontinuation was 100% pre- and postintervention. Compliance rates improved for glucose control (p = 0.007) and urinary catheter removal (p = 0.05). Documentation of β-blocker therapy (nonexistent preintervention) was 100% postintervention. Composite compliance for all measures increased from 53% to 84% (p = 0.002). There were no complications related to institution of the Surgical Care Improvement Project measures. There was no in-hospital mortality. Conclusions: Compliance with the national adult postoperative performance measures can be excellent in a children's hospital with the help of Clinical Decision Support tools. This represents an important step toward providing high-quality care to a growing population of adults with congenital heart disease who may receive care in a pediatric center.
Databáze:	MEDLINE
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