RESUMO
Care and outcomes for the more than 40,000 patients undergoing pediatric and congenital heart surgery in the United States annually are known to vary widely. While consensus recommendations have been published across numerous ï¬elds as one mechanism to promote a high level of care delivery across centers, it has been more than two decades since the last pediatric heart surgery recommendations were published in the United States. More recent guidance is lacking, and collaborative efforts involving the many disciplines engaged in caring for these children have not been undertaken to date. The present initiative brings together professional societies spanning numerous care domains and congenital cardiac surgeons, pediatric cardiologists, nursing, and other healthcare professionals from diverse programs around the country to develop consensus recommendations for United States centers. The focus of this initial work is on pediatric heart surgery, and it is recommended that future efforts focus in detail on the adult congenital population. We describe the background, rationale, and methodology related to this collaborative effort, and recommendations put forth for Essential Care Centers (essential services necessary for any program), and Comprehensive Care Centers (services to optimize comprehensive and high-complexity care), encompassing structure, process, and outcome metrics across 14 domains.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Adulto , Humanos , Criança , Estados Unidos , Cardiopatias Congênitas/cirurgia , Cardiopatias Congênitas/etiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Atenção à SaúdeRESUMO
Care and outcomes for the more than 40,000 patients undergoing pediatric and congenital heart surgery in the United States annually are known to vary widely. While consensus recommendations have been published across numerous fields as one mechanism to promote a high level of care delivery across centers, it has been more than two decades since the last pediatric heart surgery recommendations were published in the United States. More recent guidance is lacking, and collaborative efforts involving the many disciplines engaged in caring for these children have not been undertaken to date. The present initiative brings together professional societies spanning numerous care domains and congenital cardiac surgeons, pediatric cardiologists, nursing, and other healthcare professionals from diverse programs around the country to develop consensus recommendations for United States centers. The focus of this initial work is on pediatric heart surgery, and it is recommended that future efforts focus in detail on the adult congenital population. We describe the background, rationale, and methodology related to this collaborative effort, and recommendations put forth for Essential Care Centers (essential services necessary for any program), and Comprehensive Care Centers (services to optimize comprehensive and high-complexity care), encompassing structure, process, and outcome metrics across 14 domains.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Adulto , Humanos , Criança , Estados Unidos , Cardiopatias Congênitas/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Atenção à Saúde , ConsensoRESUMO
Care and outcomes for the more than 40,000 patients undergoing pediatric and congenital heart surgery in the United States annually are known to vary widely. While consensus recommendations have been published across numerous fields as one mechanism to promote a high level of care delivery across centers, it has been more than two decades since the last pediatric heart surgery recommendations were published in the United States. More recent guidance is lacking, and collaborative efforts involving the many disciplines engaged in caring for these children have not been undertaken to date. The present initiative brings together professional societies spanning numerous care domains and congenital cardiac surgeons, pediatric cardiologists, nursing, and other healthcare professionals from diverse programs around the country to develop consensus recommendations for United States centers. The focus of this initial work is on pediatric heart surgery, and it is recommended that future efforts focus in detail on the adult congenital population. We describe the background, rationale, and methodology related to this collaborative effort, and recommendations put forth for Essential Care Centers (essential services necessary for any program), and Comprehensive Care Centers (services to optimize comprehensive and high-complexity care), encompassing structure, process, and outcome metrics across 14 domains.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Cirurgiões , Adulto , Humanos , Criança , CoraçãoAssuntos
Betacoronavirus/patogenicidade , Procedimentos Cirúrgicos Cardíacos , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Prestação Integrada de Cuidados de Saúde/organização & administração , Cardiopatias Congênitas/cirurgia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Atitude do Pessoal de Saúde , COVID-19 , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Tomada de Decisão Clínica , Comportamento Cooperativo , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Cardiopatias Congênitas/epidemiologia , Humanos , Controle de Infecções/organização & administração , Comunicação Interdisciplinar , Liderança , Saúde Ocupacional , Equipe de Assistência ao Paciente/organização & administração , Segurança do Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , SARS-CoV-2 , Triagem/organização & administração , VirulênciaRESUMO
The objective of this study is to simulate regionalization of congenital heart surgery (CHS) in the United States and assess the impact of such a system on travel distance and mortality. Patients ≤18 years of age who underwent CHS were identified in 2012 State Inpatient Databases. Operations were stratified by the Risk Adjustment for Congenital Heart Surgery, version 1 (RACHS-1) method, with high risk defined as RACHS-1 levels 4-6. Regionalization was simulated by progressive closure of hospitals, beginning with the lowest volume hospital. Patients were moved to the next closest hospital. Analyses were conducted (1) maintaining original hospital mortality rates and (2) estimating mortality rates based on predicted surgical volumes after absorbing moved patients. One hundred fifty-three hospitals from 36 states performed 1 or more operation (19,064 operations). With regionalization wherein, all hospitals performed >310 operations, 37 hospitals remained, from 12.5% to 17.4% fewer deaths occurred (83-116/666), and median patient travel distance increased from 38.5 to 69.6 miles (P < 0.01). When only high-risk operations were regionalized, 3.9-5.9% fewer deaths occurred (26-39/666), and the overall mortality rate did not change significantly. Regionalization of CHS in the United States to higher volume centers may reduce mortality with minimal increase in patient travel distance. Much of the mortality reduction may be missed if solely high-risk patients are regionalized.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Serviço Hospitalar de Cardiologia/organização & administração , Serviços Centralizados no Hospital/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Cardiopatias Congênitas/cirurgia , Hospitais com Alto Volume de Atendimentos , Avaliação de Processos e Resultados em Cuidados de Saúde/organização & administração , Regionalização da Saúde/organização & administração , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Área Programática de Saúde , Bases de Dados Factuais , Acessibilidade aos Serviços de Saúde/organização & administração , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/mortalidade , Humanos , Segurança do Paciente , Melhoria de Qualidade/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Medição de Risco , Fatores de Risco , Viagem , Resultado do Tratamento , Estados UnidosRESUMO
BACKGROUND: Abdominal cardiac implantable electronic device maintenance procedures are traditionally performed by cardiac surgeons. The University of Michigan Congenital Heart Center transitioned from this practice model to one in which electrophysiologists perform the majority of these procedures. This study presents the outcomes of these procedures during this transition. METHODS: Retrospective cohort study of all patients undergoing abdominal device maintenance procedure, inclusive of generator change, removal, or placement with preexisting leads from January 2005 to July 2013. Procedures involving epicardial lead placement were excluded. The primary outcome was major complications defined as any intraoperative complication, the requirement of an additional operative intervention, or hospitalization for device-related infection. RESULTS: There were 113 procedures on 93 patients. Of these, 84 (74%) procedures were on patients with congenital heart disease. Cardiac surgeons performed 54 (48%) procedures and electrophysiologists performed 59 (52%). Mean age was 16 ± 11 years. The groups were similar regarding age and proportion with congenital heart disease (CHD). Major complications occurred in 3 (5.5%) cardiac surgeon procedures and 2 (3.4%) electrophysiologist procedures. There is no difference in the risk of major complications between groups (P = .59). CONCLUSION: This 8.5-year period encompassed a practice model transition from cardiac surgeon-performed abdominal device procedures to primarily electrophysiologist-performed abdominal device procedures. There was no difference in the risk of complications between services. This suggests that electrophysiologist-performed abdominal cardiac device maintenance procedures are a viable practice model, provided there is support and collaboration from the cardiac surgery service.