Association Between Implementation of a Cardiovascular Step-Down Unit and Process-of-Care Outcomes in Patients With Congenital Heart Disease.
BACKGROUND
The Joint Commission's 2009 National Patient Safety Goals aimed to improve identification of and response to clinical deterioration in hospital-ward patients. Some hospitals implemented intermediate-care units for patients without intensive care-level support needs. No studies have evaluated what effect changes associated with a move to a pediatric cardiovascular step-down unit (CVSDU) has on process-of-care outcomes.


METHODS
A retrospective cohort study comparing process-of-care outcomes in units caring for children with congenital heart disease (n=1415) 1 year before (July 1, 2010-June 30, 2011) and 1 year after (August 1, 2011-July 30, 2012) implementation of a CVSDU following the move to a new hospital building. Units caring for noncardiac tracheostomy and/or ventilator-dependent patients were used as controls (n=606). Primary outcomes included length of stay (LOS) and transfers to higher levels of care. Secondary outcomes included rapid response team, cardiopulmonary arrest, and code blue rates. Mann-Whitney U and z tests were used for all analyses.


RESULTS
When compared with a medical-surgical unit, cardiac patients admitted to a CVSDU had a significantly decreased total LOS (median 7.0 vs 5.4 days, P=.03), non-ICU LOS (median 3.5 vs 3.0 days, P=.006), and rapid response team/code blue rate per 1000 non-ICU patient days (11.2 vs 7.0, P=.04). No significant differences in primary or secondary outcomes were seen within the control group.


CONCLUSIONS
Changes associated with a new CVSDU were associated with decreased LOS and lower rates of rapid response and code blue events for patients with congenital heart disease.
Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California rzipkin@chla.usc.edu.
Ronen
R
Zipkin
Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California.
Kathleen
K
Ostrom
Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California.
Abiola
A
Olowoyeye
Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California.
Barry
B
Markovitz
Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California.
Sheree M
SM
Schrager
D002648:Child; D002675:Child, Preschool; D003325:Coronary Care Units / Q000592:standards*; D003327:Coronary Disease / Q000150:complications / Q000628:therapy*; D005260:Female; D006323:Heart Arrest / Q000517:prevention & control; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000592:standards; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer; D012131:Respiratory Insufficiency / Q000517:prevention & control; D012189:Retrospective Studies
cardiopulmonary arrest; cardiovascular care unit; hospital stay; outcome measures; rapid response team