title: Implementation of a comprehensive interdisciplinary care coordination of infants and young children on Berlin Heart ventricular assist devices.
abstract: BACKGROUND
  Young children supported on a ventricular assist device (VAD) can have prolonged hospitalizations awaiting heart transplantation. The adult VAD literature demonstrates that comprehensive programs optimize transplantation outcomes. The goal of this intervention was to create an interdisciplinary program to optimize care coordination and delivery in young children requiring a VAD.
  
  
  METHODS
  This study was a case review.
  
  
  RESULTS
  We have supported 8 infants and young children with Berlin Heart VAD. These children's hospitalizations have been more complex than those of our older VAD patients, and they have required intensive care for prolonged periods. An interdisciplinary group evaluated our practices and identified areas for potential improvement. The focus group from our intensive care unit introduced multiple interventions to optimize interdisciplinary care coordination and consistency of practice. These included (1) interdisciplinary care guidelines for chronically, critically ill patients; (2) institution of a primary cardiovascular intensive care unit (CVICU) physician and nurse practitioner system; (3) introduction of a psychological intervention for families to minimize the impact of their extended CVICU stay; (4) implementation of early jejunal feeds; (5) a focused developmental and rehabilitation protocol, 6) implementation of a structured approach to minimizing blood transfusions; (7) increased structure for our interdisciplinary rounds to optimize team communication; (8) comprehensive nursing education including wound care, anticoagulation management, and laboratory draws; and (9) a protocol for off-unit rehabilitative/developmental interventions. These changes in both practice and approach for young VAD patients have also been of benefit to other chronically, critically ill children in the CVICU, as well as to our CVICU team.
  
  
  CONCLUSIONS
  Comprehensive interdisciplinary care coordination and standardized practice can be achieved in the critical care setting for complex pediatric heart failure patients who require long-term VAD support.
authors.affiliation: Lucile Packard Children's Hospital at Stanford, Palo Alto, California, USA. sstaveski@lpch.org
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Staveski
authors.forename: Sonja
authors.initials: S
authors.lastname: Avery
authors.forename: David N
authors.initials: DN
authors.lastname: Rosenthal
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Roth
authors.forename: Gail E
authors.initials: GE
authors.lastname: Wright
mesh_terms: D002675:Child, Preschool; D003191:Comprehensive Health Care / Q000458:organization & administration* / Q000592:standards; D003266:Continuity of Patient Care / Q000458:organization & administration*; D006284:Health Plan Implementation; D016027:Heart Transplantation / Q000523:psychology / Q000534:rehabilitation; D006353:Heart-Assist Devices / Q000523:psychology; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D010348:Patient Care Team / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D012015:Reference Standards