scholarly journals What are the important morbidities associated with paediatric cardiac surgery? A mixed methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e028533 ◽  
Author(s):  
Katherine L Brown ◽  
Christina Pagel ◽  
Deborah Ridout ◽  
Jo Wray ◽  
David Anderson ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mixed Methods ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Early Mortality ◽  
Mixed Methods Study ◽  
Feeding Problems ◽  
Safety Outcome ◽  
Paediatric Cardiac Surgery ◽  
The Impact

ObjectivesGiven the current excellent early mortality rates for paediatric cardiac surgery, stakeholders believe that this important safety outcome should be supplemented by a wider range of measures. Our objectives were to prospectively measure the incidence of morbidities following paediatric cardiac surgery and to evaluate their clinical and health-economic impact over 6 months.DesignThe design was a prospective, multicentre, multidisciplinary mixed methods study.SettingThe setting was 5 of the 10 paediatric cardiac surgery centres in the UK with 21 months recruitment.ParticipantsIncluded were 3090 paediatric cardiac surgeries, of which 666 patients were recruited to an impact substudy.ResultsFamilies and clinicians prioritised:Acute neurological event, unplanned re-intervention, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, postsurgical infection and prolonged pleural effusion or chylothorax.Among 3090 consecutive surgeries, there were 675 (21.8%) with at least one of these morbidities. Independent risk factors for morbidity included neonatal age, complex heart disease and prolonged cardiopulmonary bypass (p<0.001). Among patients with morbidity, 6-month survival was 88.2% (95% CI 85.4 to 90.6) compared with 99.3% (95% CI 98.9 to 99.6) with none of the morbidities (p<0.001). The impact substudy in 340 children with morbidity and 326 control children with no morbidity indicated that morbidity-related impairment in quality of life improved between 6 weeks and 6 months. When compared with children with no morbidities, those with morbidity experienced a median of 13 (95% CI 10.2 to 15.8, p<0.001) fewer days at home by 6 months, and an adjusted incremental cost of £21 292 (95% CI £17 694 to £32 423, p<0.001).ConclusionsEvaluation of postoperative morbidity is more complicated than measuring early mortality. However, tracking morbidity after paediatric cardiac surgery over 6 months offers stakeholders important data that are of value to parents and will be useful in driving future quality improvement.

scholarly journals Definition of important early morbidities related to paediatric cardiac surgery

2016 ◽  
Vol 27 (4) ◽  
pp. 747-756 ◽  
Author(s):  
Katherine L. Brown ◽  
Christina Pagel ◽  
Rhian Brimmell ◽  
Kate Bull ◽  
Peter Davis ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Life Support ◽  
Blood Stream Infection ◽  
Extracorporeal Life Support ◽  
Blood Stream ◽  
Feeding Problems ◽  
Cardiac Events ◽  
Multi Centre Study ◽  
Paediatric Cardiac Surgery ◽  
The Impact

AbstractBackgroundMorbidity is defined as a state of being unhealthy or of experiencing an aspect of health that is “generally bad for you”, and postoperative morbidity linked to paediatric cardiac surgery encompasses a range of conditions that may impact the patient and are potential targets for quality assurance.MethodsAs part of a wider study, a multi-disciplinary group of professionals aimed to define a list of morbidities linked to paediatric cardiac surgery that was prioritised by a panel reflecting the views of both professionals from a range of disciplines and settings as well as parents and patients.ResultsWe present a set of definitions of morbidity for use in routine audit after paediatric cardiac surgery. These morbidities are ranked in priority order as acute neurological event, unplanned re-operation, feeding problems, the need for renal support, major adverse cardiac events or never events, extracorporeal life support, necrotising enterocolitis, surgical site of blood stream infection, and prolonged pleural effusion or chylothorax. It is recognised that more than one such morbidity may arise in the same patient and these are referred to as multiple morbidities, except in the case of extracorporeal life support, which is a stand-alone constellation of morbidity.ConclusionsIt is feasible to define a range of paediatric cardiac surgical morbidities for use in routine audit that reflects the priorities of both professionals and parents. The impact of these morbidities on the patient and family will be explored prospectively as part of a wider ongoing, multi-centre study.

scholarly journals Early morbidities following paediatric cardiac surgery: a mixed-methods study

2020 ◽  
Vol 8 (30) ◽  
pp. 1-192
Author(s):  
Katherine L Brown ◽  
Christina Pagel ◽  
Deborah Ridout ◽  
Jo Wray ◽  
Victor T Tsang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiac Surgery ◽  
Health Services ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Mixed Methods Study ◽  
Feeding Problems ◽  
Developmental Assessment ◽  
Routine Monitoring

Background Over 5000 paediatric cardiac surgeries are performed in the UK each year and early survival has improved to > 98%. Objectives We aimed to identify the surgical morbidities that present the greatest burden for patients and health services and to develop and pilot routine monitoring and feedback. Design and setting Our multidisciplinary mixed-methods study took place over 52 months across five UK paediatric cardiac surgery centres. Participants The participants were children aged < 17 years. Methods We reviewed existing literature, ran three focus groups and undertook a family online discussion forum moderated by the Children’s Heart Federation. A multidisciplinary group, with patient and carer involvement, then ranked and selected nine key morbidities informed by clinical views on definitions and feasibility of routine monitoring. We validated a new, nurse-administered early warning tool for assessing preoperative and postoperative child development, called the brief developmental assessment, by testing this among 1200 children. We measured morbidity incidence in 3090 consecutive surgical admissions over 21 months and explored risk factors for morbidity. We measured the impact of morbidities on quality of life, clinical burden and costs to the NHS and families over 6 months in 666 children, 340 (51%) of whom had at least one morbidity. We developed and piloted methods suitable for routine monitoring of morbidity by centres and co-developed new patient information about morbidities with parents and user groups. Results Families and clinicians prioritised overlapping but also different morbidities, leading to a final list of acute neurological event, unplanned reoperation, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotising enterocolitis, surgical infection and prolonged pleural effusion. The brief developmental assessment was valid in children aged between 4 months and 5 years, but not in the youngest babies or 5- to 17-year-olds. A total of 2415 (78.2%) procedures had no measured morbidity. There was a higher risk of morbidity in neonates, complex congenital heart disease, increased preoperative severity of illness and with prolonged bypass. Patients with any morbidity had a 6-month survival of 81.5% compared with 99.1% with no morbidity. Patients with any morbidity scored 5.2 points lower on their total quality of life score at 6 weeks, but this difference had narrowed by 6 months. Morbidity led to fewer days at home by 6 months and higher costs. Extracorporeal life support patients had the lowest days at home (median: 43 days out of 183 days) and highest costs (£71,051 higher than no morbidity). Limitations Monitoring of morbidity is more complex than mortality, and hence this requires resources and clinician buy-in. Conclusions Evaluation of postoperative morbidity provides important information over and above 30-day survival and should become the focus of audit and quality improvement. Future work National audit of morbidities has been initiated. Further research is needed to understand the implications of feeding problems and renal failure and to evaluate the brief developmental assessment. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 30. See the NIHR Journals Library website for further project information.

scholarly journals The Impact of Non-Pharmacological Interventions on Patient Experience, Opioid Use, and Healthcare Utilization in Adult Cardiac Surgery Patients: Protocol for a Mixed Methods Study (Preprint)

2020 ◽  
Author(s):  
Alexander A. Brescia ◽  
Julie R. Piazza ◽  
Jessica N. Jenkins ◽  
Lindsay K. Heering ◽  
Alexander J. Ivacko ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mixed Methods ◽  
Healthcare Utilization ◽  
Patient Experience ◽  
Mixed Methods Study ◽  
Opioid Use ◽  
Pharmacological Interventions ◽  
The Impact ◽  
Adult Cardiac Surgery

BACKGROUND Despite pharmacological treatments, patients undergoing cardiac surgery experience severe anxiety and pain which adversely impact outcomes. Prior work examining pediatric and non-surgical adult patients has documented the effectiveness of inexpensive non-pharmacological techniques to reduce anxiety and pain, as well as healthcare costs and length of hospitalization. However, the impact of non-pharmacological interventions administered by a dedicated “comfort coach” has not been evaluated in an adult surgical setting. OBJECTIVE The objective of this trial is to assess whether non-pharmacological interventions administered by a trained comfort coach impact patient experience, opioid use, and healthcare utilization compared to usual care in adult cardiac surgery patients. This study has three specific aims: (1) assess the effect of a comfort coach on patient experience, (2) measure differences in inpatient and outpatient opioid use and postoperative healthcare utilization, and (3) qualitatively evaluate the comfort coach intervention. METHODS To address these aims, we will perform a prospective, randomized controlled trial of 154 adult cardiac surgery patients at Michigan Medicine. Opioid-naive patients undergoing first-time, elective cardiac surgery via sternotomy will be randomized to undergo targeted interventions from a comfort coach (intervention) versus usual care (control). The individualized comfort coach interventions will be administered at six points: (1) preoperative outpatient clinic, (2) preoperative care unit on the day of surgery, (3) extubation, (4) chest tube removal, (5) hospital discharge, and (6) at 30-day clinic follow-up. To address aim 1, we will examine the effect of a comfort coach on perioperative anxiety, self-reported pain, functional status, and patient satisfaction through validated surveys administered at (1) preoperative outpatient clinic, (2) discharge, (3) 30-day follow-up, and (4) 90-day follow-up. For aim 2, we will record inpatient opioid use and collect post-discharge opioid use and pain-related outcomes through an 11-item questionnaire administered at 30-day follow-up. Hospital length of stay, readmission, number of days in an extended care facility, emergency room, urgent care, and at an unplanned doctor’s office visit will be recorded as the primary composite endpoint defined as total days spent at home within the first 30 after surgery. For aim 3, we will perform semi-structured interviews with patients in the intervention arm to understand the comfort coach intervention through a thematic analysis. RESULTS This trial, funded by Blue Cross Blue Shield Foundation of Michigan in 2019, is presently enrolling patients with anticipated manuscript submissions Data generated from this mixed methods study will highlight effective non-pharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. Findings from this study may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery.from our primary aims targeted for the end of 2020. CONCLUSIONS Data generated from this mixed methods study will highlight effective non-pharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. Findings from this study may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery. CLINICALTRIAL ClinicalTrials.gov NCT04051021; https://clinicaltrials.gov/ct2/show/NCT04051021.

scholarly journals Acute care nurses’ perceptions of leadership, teamwork, turnover intention and patient safety – a mixed methods study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Shahram Zaheer ◽  
Liane Ginsburg ◽  
Hannah J. Wong ◽  
Kelly Thomson ◽  
Lorna Bain ◽  
...  
Keyword(s):  
Patient Safety ◽  
Mixed Methods ◽  
Turnover Intention ◽  
Interactive Effect ◽  
Mixed Methods Study ◽  
Senior Leadership ◽  
Healthcare Organizations ◽  
Staff Perceptions ◽  
Leadership Support ◽  
The Impact

Abstract Background This study contributes to a small but growing body of literature on how context influences perceptions of patient safety in healthcare settings. We examine the impact of senior leadership support for safety, supervisory leadership support for safety, teamwork, and turnover intention on overall patient safety grade. Interaction effects of predictors on perceptions of patient safety are also examined. Methods In this mixed methods study, cross-sectional survey data (N = 185) were collected from nurses and non-physician healthcare professionals. Semi-structured interview data (N = 15) were collected from nurses. The study participants worked in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario. Results Hierarchical regression analyses showed that staff perceptions of senior leadership (p < 0.001), teamwork (p < 0.01), and turnover intention (p < 0.01) were significantly associated with overall patient safety grade. The interactive effect of teamwork and turnover intention on overall patient safety grade was also found to be significant (p < 0.05). The qualitative findings corroborated the survey results but also helped expand the characteristics of the study’s key concepts (e.g., teamwork within and across professional boundaries) and why certain statistical relationships were found to be non-significant (e.g., nurse interviewees perceived the safety specific responsibilities of frontline supervisors much more broadly compared to the narrower conceptualization of the construct in the survey). Conclusions The results of the current study suggest that senior leadership, teamwork, and turnover intention significantly impact nursing staff perceptions of patient safety. Leadership is a modifiable contextual factor and resources should be dedicated to strengthen relational competencies of healthcare leaders. Healthcare organizations must also proactively foster inter and intra-professional collaboration by providing teamwork educational workshops or other on-site learning opportunities (e.g., simulation training). Healthcare organizations would benefit by considering the interactive effect of contextual factors as another lever for patient safety improvement, e.g., lowering staff turnover intentions would maximize the positive impact of teamwork improvement initiatives on patient safety.

scholarly journals Protracted aortic valve closure during peripheral veno-arterial extracorporeal life support: is intra-aortic balloon pump an effective solution?

Perfusion ◽  
2018 ◽  
Vol 34 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Paolo Meani ◽  
Thijs Delnoij ◽  
Giuseppe M. Raffa ◽  
Nuccia Morici ◽  
Giovanna Viola ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Left Ventricular ◽  
Ecmo Support ◽  
Effective Solution ◽  
Intra Aortic Balloon Pump ◽  
University Center ◽  
Aortic Valve Closure ◽  
The Impact

Background: Left ventricular (LV) afterload increase with protracted aortic valve (AV) closure may represent a complication of veno-arterial extracorporeal membrane oxygenation (V-A ECMO). The aim of the present study was to assess the effects of an intra-aortic balloon pump (IABP) to overcome such a hemodynamic shortcoming in patients submitted to peripheral V-A ECMO. Methods: Among 184 adult patients who were treated with peripheral V-A ECMO support at Medical University Center Maastricht Hospital between 2007 and 2018, patients submitted to IABP implant for protracted AV closure after V-A ECMO implant were retrospectively identified. All clinical and hemodynamic data, including echocardiographic monitoring, were collected and analyzed. Results: During the study period, 10 subjects (mean age 60 years old, 80% males) underwent IABP implant after peripheral V-A ECMO positioning due to the diagnosis of protracted AV closure and inefficient LV unloading as assessed by echocardiography and an absence of pulsation in the arterial pressure wave. Recovery of blood pressure pulsatility and enhanced LV unloading were observed in 8 patients after IABP placement, with no significant differences in the main hemodynamic parameters, inotropic therapy or in the ECMO flow (p=0.48). The weaning rate in this patient subgroup (mean ECMO duration 8 days), however, was only 10%, with another patient finally transplanted, leading to a 20% survival-to-hospital discharge. Conclusion: IABP placement was an effective solution in order to reverse the protracted AV closure and impaired LV unloading observed during peripheral V-A ECMO support. However, the impact on the weaning rate and survival needs further investigations.

Sign in / Sign up

Export Citation Format

Share Document