Clinical pathway for the Fontan patient to standardise care and improve outcomes
| Autor: | Suma Goudar, Megan Jensen, Bryan Beaven, Sarah M Lagergren |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Heart Defects
Congenital medicine.medical_specialty Quality management medicine.medical_treatment Fontan Procedure Fontan procedure Pleural drainage Clinical pathway Health care medicine Humans Stage (cooking) Child Retrospective Studies business.industry Electronic medical record General Medicine Length of Stay Treatment Outcome Pediatrics Perinatology and Child Health Emergency medicine Critical Pathways Drainage Fluid restriction Cardiology and Cardiovascular Medicine business |
| Zdroj: | Cardiology in the Young. 30:1247-1252 |
| ISSN: | 1467-1107 1047-9511 |
| Popis: | Introduction:The Fontan procedure is the final stage of surgical palliation for the children with functionally single ventricle anatomy. The post-operative medical management of this patient population can be variable and hospital length of stay prolonged. The purpose of this quality improvement project was to determine if the implementation of an evidence-based clinical pathway for post-operative management of the Fontan patient at a large Midwestern academic paediatric medical centre would standardise care and decrease length of stay.Materials and methods:The clinical pathway was developed using key components from three published pathways for the Fontan procedure from other paediatric institutions across the United States. Components of the clinical pathway included (1) supplemental oxygen until pleural drainage tubes are removed, (2) fluid restriction to 80% daily maintenance and a prescribed low-fat diet, (3) aggressive and standardised diuretic therapy while inpatient and (4) central venous access. The pathway was trialed using Plan-Do-Study-Act cycles in 2016, implemented in 2017 and sustained in 2018–2019. A retrospective electronic medical record review was performed to compare key outcomes from pre-pathway (2014–2015, 37 patients) with post-pathway implementation (2017–2018, 30 patients).Results:Adherence to the pathway was nearly 100% with a statistically significant decrease in length of stay from 12 to 9 days (p = 0.007) and no increase in readmissions.Conclusion:Standardising care can improve clinical and financial outcomes for the Fontan patient population without negatively impacting quality of care, thus providing a positive benefit to the healthcare institution, industry and patient. |
| Databáze: | OpenAIRE |
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