Experience with an Acuity Adaptable Care Model for Pediatric Cardiac Surgery

John M Costello, Elizabeth Preze, Nguyenvu T Nguyen, Mary E. McBride, James W. Collins, Osama M. Eltayeb, Michael C. Mongé, Barbara J. Deal, Michelle M. Stephenson, Carl L. Backer

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

BACKGROUND: We describe the implementation of and outcomes associated with an acuity adaptable care model for pediatric patients undergoing cardiac surgery.

METHODS: Consecutive patients undergoing an index cardiac operation between July 2007 and June 2015 were included. From July 2007 through June 2010, a conventional model existed in which patients moved among units and care teams based on age, severity of illness, and operative status (conventional group). A transitional period existed between July 2010 and June 8, 2012 (transitional group). From June 9, 2012, through June 2015, an acuity adaptable model was used in which patients remained in the cardiac care unit and received care from the same clinical team throughout their hospitalization (acuity adaptable group).

RESULTS: Included were 2,363 patients: 925 in the conventional group, 520 in the transitional group, and 918 in the acuity adaptable group. In relation to the conventional group, the adjusted odds of operative mortality in the acuity adaptable group was 0.55 (95% confidence interval: 0.26-1.18; P = .12). The failure to rescue rate (ie, number of deaths in patients with any complication divided by the number of total patients with any complication) decreased (conventional group, 8.7%; acuity adaptable group, 4.2%; P = .04). In relation to the conventional group, postoperative hospital length of stay tended to be shorter in the acuity adaptable group ( P = .07).

CONCLUSIONS: The implementation of an acuity adaptable care model was feasible in our pediatric cardiac program. The favorable associations identified between the new model and outcomes are promising but warrant confirmation in a larger, multicenter study.

Original languageEnglish (US)
Pages (from-to)665-671
Number of pages7
JournalWorld journal for pediatric & congenital heart surgery
Volume8
Issue number6
DOIs
StatePublished - Nov 1 2017

Keywords

  • complications
  • intensive care
  • nursing
  • outcomes
  • perioperative care
  • surgery

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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