title: Home monitoring program reduces interstage mortality after the modified Norwood procedure.
abstract: BACKGROUND
  From 2002 to 2005, the interstage mortality after a modified Norwood procedure was 7% in our program. An interstage home monitoring program (HMP) was established to identify Norwood procedure patients at increased risk of decompensation and to reduce interstage mortality.
  
  
  METHODS
  Results of the first 5 years of the Norwood HMP were reviewed retrospectively. Interstage was defined as the time between Norwood hospital discharge and admission for second stage surgical palliation. In the HMP, families documented oxygen saturation, heart rate, weight, and feedings daily. Nurse practitioners called each family at least weekly, and when issues arose, action plans were determined based on symptom severity.
  
  
  RESULTS
  Between October 2005 and October 2010 there were 46 Norwood procedure patients who survived to hospital discharge. All were enrolled in the HMP. Forty-five patients had a Norwood procedure with right ventricle to pulmonary artery conduit, and 1 patient had a modified Blalock-Taussig shunt. Interstage survival was 100%. Nineteen patients (41%) were admitted interstage; 5 patients were admitted twice, 1 patient was admitted 4 times. Seventeen patients (37%) required interstage interventions. Eight patients (17%) required major interventions: conduit stenting, aortic arch balloon angioplasty, emergent shunt, or early Glenn surgery. Minor interventions included supplemental oxygen, blood transfusion, intravenous hydration, diuresis, anti-arrhythmic therapy, or feeding adjustments.
  
  
  CONCLUSIONS
  In the first 5 years of the HMP, all infants discharged after a modified Norwood procedure survived the interstage period. The HMP altered clinical management in 37% of patients. Home monitoring of oxygen saturation, heart rate, weight, and feedings, along with comprehensive care coordination, allowed timely interventions and reduced interstage mortality from 7% to 0%.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Siehr
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: Jana K
authors.initials: JK
authors.lastname: Norris
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Bushnell
authors.affiliation: Department of Anesthesia, Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: Chandra
authors.initials: C
authors.lastname: Ramamoorthy
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: V Mohan
authors.initials: VM
authors.lastname: Reddy
authors.affiliation: Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, Calif.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Hanley
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif. Electronic address: gewright@stanford.edu.
authors.forename: Gail E
authors.initials: GE
authors.lastname: Wright
mesh_terms: D001835:Body Weight; D004435:Eating; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006333:Heart Failure / Q000097:blood / Q000209:etiology / Q000401:mortality* / Q000451:nursing / Q000503:physiopathology / Q000517:prevention & control; D006339:Heart Rate; D018575:Home Care Services, Hospital-Based; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008297:Male; D058327:Norwood Procedures / Q000009:adverse effects / Q000401:mortality*; D009722:Nurse Practitioners; D009752:Nutritional Status; D010100:Oxygen / Q000097:blood; D010351:Patient Discharge; D010359:Patient Readmission; D015397:Program Evaluation; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: 20; HMP; LPCH; Lucile Packard Children’s Hospital; NG; NP; RV-PA; home monitoring program; mBTS; modified Blalock-Taussig shunt; nasogastric; nurse practitioner; right ventricle to pulmonary artery