Abstract 13218: Variation in Interstage Outpatient Care after the Norwood Procedure: Report from the National Quality Improvement Collaborative
The NPC-QIC is the first quality improvement collaborative in pediatric cardiology, and its registry captures information on interstage care and outcomes of infants after the Norwood procedure. The purpose of this study is to evaluate variation in interstage practices and outpatient care in infants discharged home after the Norwood procedure. Data for the first 100 infants enrolled in the NPC-QIC registry were evaluated for 1) discharge communication with primary care physician (PCP) and cardiologist, 2) route of nutrition at hospital discharge, and 3) utilization of home surveillance strategies. The 100 infants were discharged home, July 2008 to February 2010, after the Norwood operation at 21 participating U.S. cardiology programs. Median age at discharge was 29 (11-188) days. Interstage outpatient care was provided by the Norwood center for 62 infants, by other centers (including private cardiologists) for 25, and by a combination of centers for 13. Communication at Norwood discharge was highly variable. Complete communication (defined as including medication list, nutrition plan, and red flag checklist) was relayed to 45% of cardiologists and to only 25% of PCPs. Nutrition route at discharge also varied widely and was exclusively oral in 49, combined oral and NG/NJ in 38, exclusively NG/NJ in 6, combined oral and GT in 6, and exclusively GT in 1 child. Home surveillance strategies were employed in 81 (daily SpO2 and weight monitoring in 77, daily SpO2 monitoring alone in 4), with no home surveillance in 19 infants.
In conclusion, considerable variation exists in interstage outpatient care after the Norwood procedure particularly in the areas of discharge communication, nutrition, and home surveillance. Variation may contribute to interstage morbidity and mortality. Standardizing care around evidence-based practices may improve the outcomes for these high-risk children.
- © 2010 by American Heart Association, Inc.