Standardized Training for Physicians Practicing Pediatric Cardiac Critical Care

AbstractAs pediatric cardiac critical care becomes more sub-specialized it is reasonable to assume that dedicated units may provide a better infrastructure for improved multidisciplinary care, cardiac-specific patient safety initiatives, and dedicated training of fellows and residents. The knowledge base required to optimally manage pediatric patients with critical cardiac disease has evolved sufficiently to consider a standardized training curriculum and board certification for pediatric cardiac critical care. This strategy would potentially provide consistency of training and healthcare and improve quality of care and patient safety.

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266 Performance assessment of French guidelines for the management of STEMI patients out of cardiac critical care unit on clinical practices: insights from the e-MUST registry

BMJ Quality & Safety ◽

10.1136/qshc.2010.041624.59 ◽

2010 ◽

Vol 19 (Suppl 1) ◽

pp. A106-A107

Author(s):

S. Bataille ◽

J.-P. Tresca ◽

X. Mouranche ◽

M. Mapouata ◽

A. Greffet ◽

...

Keyword(s):

Critical Care ◽

Performance Assessment ◽

Critical Care Unit ◽

Clinical Practices ◽

Cardiac Critical Care

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A Multi-Institutional Simulation Boot Camp for Pediatric Cardiac Critical Care Nurse Practitioners*

Pediatric Critical Care Medicine ◽

10.1097/pcc.0000000000001532 ◽

2018 ◽

Vol 19 (6) ◽

pp. 564-571 ◽

Cited By ~ 7

Author(s):

Kristen M. Brown ◽

Shawna S. Mudd ◽

Elizabeth A. Hunt ◽

Julianne S. Perretta ◽

Nicole A. Shilkofski ◽

...

Keyword(s):

Critical Care ◽

Nurse Practitioners ◽

Boot Camp ◽

Care Nurse ◽

Critical Care Nurse ◽

Cardiac Critical Care

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Workforce demographics and unit structure in paediatric cardiac critical care in the United States

Cardiology in the Young ◽

10.1017/s1047951121004753 ◽

2021 ◽

pp. 1-5

Author(s):

Robin V. Horak ◽

Shasha Bai ◽

Bradley S. Marino ◽

David K. Werho ◽

Leslie A. Rhodes ◽

...

Keyword(s):

United States ◽

Critical Care ◽

Heart Surgery ◽

Age Groups ◽

The United States ◽

Work Hours ◽

Full Time ◽

Full Time Equivalent ◽

Unit Structure ◽

Cardiac Critical Care

Abstract Objective: To assess current demographics and duties of physicians as well as the structure of paediatric cardiac critical care in the United States. Design: REDCap surveys were sent by email from May till August 2019 to medical directors (“directors”) of critical care units at the 120 United States centres submitting data to the Society of Thoracic Surgeons Congenital Heart Surgery Database and to associated faculty from centres that provided email lists. Faculty and directors were asked about personal attributes and clinical duties. Directors were additionally asked about unit structure. Measurements and main results: Responses were received from 66% (79/120) of directors and 62% (294/477) of contacted faculty. Seventy-six percent of directors and 54% of faculty were male, however, faculty <40 years old were predominantly women. The majority of both groups were white. Median bed count (n = 20) was similar in ICUs and multi-disciplinary paediatric ICUs. The median service expectation for one clinical full-time equivalent was 14 weeks of clinical service (interquartile range 12, 16), with the majority of programmes (86%) providing in-house attending night coverage. Work hours were high during service and non-service weeks with both directors (37%) and faculty (45%). Conclusions: Racial and ethnic diversity is markedly deficient in the paediatric cardiac critical care workforce. Although the majority of faculty are male, females make up the majority of the workforce younger than 40 years old. Work hours across all age groups and unit types are high both on- and off-service, with most units providing attending in-house night coverage.

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Assessing data accuracy in a large multi-institutional quality improvement registry: an update from the Pediatric Cardiac Critical Care Consortium (PC4)

Cardiology in the Young ◽

10.1017/s1047951121004984 ◽

2021 ◽

pp. 1-6

Author(s):

Jennifer Schuette ◽

Hayden Zaccagni ◽

Janet Donohue ◽

Julie Bushnell ◽

Kelly Veneziale ◽

...

Keyword(s):

Critical Care ◽

Quality Improvement ◽

Institutional Quality ◽

Data Accuracy ◽

Broad Array ◽

Major Discrepancy ◽

Discrepancy Rate ◽

Data Auditing ◽

High Level ◽

Cardiac Critical Care

Abstract Background: The Pediatric Cardiac Critical Care Consortium (PC4) is a multi-institutional quality improvement registry focused on the care delivered in the cardiac ICU for patients with CHD and acquired heart disease. To assess data quality, a rigorous procedure of data auditing has been in place since the inception of the consortium. Materials and methods: This report describes the data auditing process and quantifies the audit results for the initial 39 audits that took place after the transition from version one to version two of the registry’s database. Results: In total, 2219 total encounters were audited for an average of 57 encounters per site. The overall data accuracy rate across all sites was 99.4%, with a major discrepancy rate of 0.52%. A passing score is based on an overall accuracy of >97% (achieved by all sites) and a major discrepancy rate of <1.5% (achieved by 38 of 39 sites, with 35 of 39 sites having a major discrepancy rate of <1%). Fields with the highest discrepancy rates included arrhythmia type, cardiac arrest count, and current surgical status. Conclusions: The extensive PC4 auditing process, including initial and routinely scheduled follow-up audits of every participating site, demonstrates an extremely high level of accuracy across a broad array of audited fields and supports the continued use of consortium data to identify best practices in paediatric cardiac critical care.

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Abstract 301: Identifying Critical Care Unit Organizational Factors That Impact Cardiac Arrest Incidence and Outcomes: A Report From the Pediatric Cardiac Critical Care Consortium

Circulation ◽

10.1161/circ.140.suppl_2.301 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Javier J Lasa ◽

Jeffrey A Alten ◽

Mousumi Banerjee ◽

Wenying Zhang ◽

Kurt Schumacher ◽

...

Keyword(s):

Cardiac Arrest ◽

Critical Care ◽

Critical Care Unit ◽

Organizational Factors ◽

Full Time ◽

Provider Education ◽

Multinomial Regression ◽

Clinical Registry ◽

The Impact ◽

Cardiac Critical Care

Introduction: Patient factors leading to cardiac arrest (CA) in the pediatric cardiac critical care unit (CICU) are well understood, but may be unmodifiable. Our understanding of the impact of CICU organizational factors (OFs) such as staffing models, health care provider education, and CICU bed management is limited. The association between these potentially modifiable CICU OFs on CA prevention and rescue outcomes is unknown. Hypothesis: CICU OFs associate with CA prevention and rescue. Methods: Retrospective analysis of Pediatric Cardiac Critical Care Consortium (PC4) clinical registry including data for all patients admitted to CICUs from August 2014 to March 2019. Prevention was defined as the prevalence of subjects not suffering CA. Rescue was defined as survival after CA. CICU OFs were captured via questionnaire distributed to PC4 participants in 2017 (100% response). Stratified, multivariable regression was used to evaluate associations between OFs and outcome in medical and surgical admission subgroups: competing time-to-events framework (to assess prevention) and multinomial regression (to assess rescue), accounting for clustering of patients within hospitals. Results: We analyzed 54,521 CICU admissions (59% surgical, 41% medical) from 29 hospitals with 1398 CA events (2.5%). We studied 12 OFs that varied across centers after accounting for collinearity. For both surgical and medical admissions, lower average daily occupancy (<80%) was associated with better arrest prevention for all admissions, and better rescue in the surgical cohort. Increased proportion of nurses with >2 years experience, increased proportion of nurses with critical care certification, % of full-time intensivists, % of intensivists with critical care training, dedicated respiratory therapists, quality/safety resources, and annual CICU admission volume were not associated with improved prevention or rescue. Conclusion: Our multi-institutional analysis suggests that lower average CICU occupancy was the only consistent OF evaluated that was associated with CA prevention and rescue. CICUs that have average daily occupancy >80% may need specific strategies to mitigate the risks of CA.

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