A novel paradigm for providing improved care to chronic patients in cardiac intensive care unit.
OBJECTIVE
Evaluate the impact of chronic cardiac care team (CCCT) on hospital course of patients, their families, and nursing staff.


METHODS
Retrospective observational study in children with hospital stay of ≥6 weeks in a pediatric cardiac intensive care unit (CICU) at a tertiary care children's hospital. Before and after care, survey of the nurses and patients family was also performed.


RESULTS
The CCCT provided care for 68 patients of which 44 survived to discharge. Median age at admission was 19 days (range 0-20.6 years); 18 (26%) were admitted at birth. Cardiac diagnosis included single ventricle in 27, heart failure/cardiac transplantation in 37, others in 6. The CCCT was involved in follow-up for vitamin and endocrine deficiencies, updating immunization status, optimizing nutritional intake, growth parameters, assess feeding issues, and providing end-of-life discussions in all those who died. One year after implementation, 85% nurses indicated improved understanding of patient problems, 57% reported improved working relationship with families, and 87% reported improved team communication. Family survey indicated that implementation of the model led to significantly improved opinion of parents in their ability to participate in the plan of care (28% vs. 70%, P = 0.019) and better relationship with the CICU staff caring for their child (57% vs. 100%, P = 0.008).


CONCLUSIONS
The CCCT provides a new team-based paradigm for improving continuity of care in chronic CICU patients by supplementing medical care and facilitates end-of-life discussions. The CCCT bridges communication gap between CICU staff and families.
Pediatric Critical Care Medicine, College of Medicine-University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Ark, USA. garciaxiomara@uams.edu
Xiomara
X
Garcia
Ritu
R
Sachdeva
Christopher J
CJ
Swearingen
Janie
J
Kane
Hillary
H
Haber
Adnan T
AT
Bhutta
Parthak
P
Prodhan
D000293:Adolescent; D001131:Arkansas; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D032882:Comprehension; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003325:Coronary Care Units / Q000458:organization & administration*; D005260:Female; D019538:Health Care Surveys; D006331:Heart Diseases / Q000175:diagnosis / Q000401:mortality / Q000451:nursing / Q000628:therapy*; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration*; D033183:Interdisciplinary Communication; D007902:Length of Stay; D008297:Male; D017146:Models, Organizational; D009937:Organizational Objectives; D010348:Patient Care Team / Q000458:organization & administration; D010351:Patient Discharge; D011368:Professional-Family Relations; D015397:Program Evaluation; D011787:Quality of Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000458:organization & administration*; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult