Abstract 4364123: Impact Of Transition To An Acute Care Cardiology Inpatient Model

Abstract

Background: Improved survival and healthcare system changes have led to increasing complexity of the typical hospitalized pediatric patient. This has led to the development of inpatient specialists such as Pediatric Hospitalists with resultant improved clinical outcomes. Similar trends in pediatric cardiology have catalyzed the creation of acute care cardiology (ACC). Yet, the broad impact on pediatric cardiology clinical outcomes secondary to the ACC inpatient model has not been previously studied prospectively. Hypothesis: Adoption of an ACC model will improve clinical outcomes. Methods: This was a QI initiative at a tertiary care children’s hospital focused on a redesign of the care model for inpatients with cardiac disease requiring non-ICU level of care through adoption of an ACC model. We selected complication rate and back transfer to ICU as outcome measures, discharge time as a process measure, and 7-day unplanned readmissions and length of stay (LOS) as balancing measures. Baseline data was gathered for 6 months and measures were prospectively studied using statistical process control charts for 12 months post-transition. Standard rules for identifying special cause variation (SCV) were applied. We compared patient and family experience scores (PFE) pre- and post-transition using an independent t-test. There were no changes in surgical or nursing staffing, beds, or average daily census between baseline and post-transition periods suggesting any changes in measures could be attributed to the ACC model and not external factors. Results: All outcome and process measures significantly improved from baseline to post-transition periods showing SCV following adoption of the ACC model (complications: 23.6% vs 16.0%; back transfer to ICU: 11.4% vs 6.9%; patient discharge time: 15:22 vs 14:26) (Figure 1). LOS and 7-day unplanned readmissions were unchanged post-transition suggesting no major inadvertent negative consequences of the ACC model (Figure 2). PFE improved post-transition ( p =0.04) (Figure 3). Conclusions: Adoption of an ACC model significantly improved outcomes and PFE without evidence of impactful negative effects. Though ACC has been widely adopted nationally, this is the first report documenting the prospectively measured impact of such a change in the established model of care. Ongoing evaluation of resource utilization, sustainability of improvement, and newly embedded improvement efforts is underway.