title: Optimizing care of adults with congenital heart disease in a pediatric cardiovascular ICU using electronic clinical decision support*.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Cardiovascular ICU in a quaternary care freestanding children's hospital.
  
  
  METHODS
  The cohort included 114 adults 18-70 years old recovering from cardiac surgery in our pediatric cardiovascular ICU.
  
  
  METHODS
  Clinical Decision Support tools including data-triggered alerts, smart documentation forms, and order sets with conditional logic were integrated into the workflow.
  
  
  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.
authors.affiliation: 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.
authors.forename: Lindsay J
authors.initials: LJ
authors.lastname: May
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Longhurst
authors.forename: Natalie M
authors.initials: NM
authors.lastname: Pageler
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Wood
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
authors.forename: C Michelle
authors.initials: CM
authors.lastname: Zebrack
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003325:Coronary Care Units; D020000:Decision Support Systems, Clinical; D005260:Female; D019983:Guideline Adherence; D006330:Heart Defects, Congenital / Q000601:surgery*; D006776:Hospitals, Pediatric; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012189:Retrospective Studies; D055815:Young Adult