Abstract 16121: Wellness in Pediatric Cardiac Intensivists - How are We Doing?

Introduction: Poor physician wellness is associated with detrimental effects on patient outcomes. There are no data on physician wellness in pediatric cardiac critical care. We aimed to define the prevalence of and risk factors for impaired wellness using a targeted survey of the North American pediatric cardiac critical care workforce. Methods: We developed a survey to examine physician wellness and potential risk factors, incorporating the Expanded Physician Well Being Index. Unit directors at 120 congenital heart surgery centers were contacted to provide faculty emails. The survey was distributed to each faculty with targeted reminders from June - September 2019. Univariate and multivariable logistic regression analyses were performed comparing the at-risk respondents to those not at risk for poor wellness. Results: Of the 477 faculty, 294 completed the survey (62%). Faculty reported working a median of 83 hours on service weeks and 50 hours on non-service weeks. Based on Well-Being scores, 34% were in the “at risk” category; 56% reported feeling burned out in the past month and 46% reported feeling overwhelmed. However, 96% felt their work was meaningful. Faculty reported a high incidence of developing unhealthy habits including poor nutrition (50%), infrequent exercise (56%), and lack of self-care (46%). Factors associated with well-being risk are shown in Table 1. Poor interpersonal experiences, higher work hours, and being primarily trained in critical care with an additional cardiac year were associated with risk of poor wellness. Working >100 hours per service week had a significant increase in risk (odds ratio 2.3, 95% confidence interval 1.31-4.40). Availability of wellness services was associated with reduced risk. Conclusion: Burnout and risk of poor wellness are common in pediatric cardiac critical care faculty. Modifiable factors, including wellness service availability and reduced hours of clinical service may improve wellness in the workforce.

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Variation in extubation failure rates after neonatal congenital heart surgery across Pediatric Cardiac Critical Care Consortium hospitals

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2016.12.042 ◽

2017 ◽

Vol 153 (6) ◽

pp. 1519-1526 ◽

Cited By ~ 19

Author(s):

Brian D. Benneyworth ◽

Christopher W. Mastropietro ◽

Eric M. Graham ◽

Darren Klugman ◽

John M. Costello ◽

...

Keyword(s):

Critical Care ◽

Congenital Heart ◽

Heart Surgery ◽

Extubation Failure ◽

Congenital Heart Surgery ◽

Failure Rates ◽

Cardiac Critical Care

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Atrioventricular block after congenital heart surgery: Analysis from the Pediatric Cardiac Critical Care Consortium

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2018.09.142 ◽

2019 ◽

Vol 157 (3) ◽

pp. 1168-1177.e2 ◽

Cited By ~ 6

Author(s):

Amy J. Romer ◽

Sarah Tabbutt ◽

Susan P. Etheridge ◽

Peter Fischbach ◽

Nancy S. Ghanayem ◽

...

Keyword(s):

Critical Care ◽

Atrioventricular Block ◽

Congenital Heart ◽

Heart Surgery ◽

Congenital Heart Surgery ◽

Cardiac Critical Care

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Reducing readmissions following paediatric cardiothoracic surgery: a quality improvement initiative

Cardiology in the Young ◽

10.1017/s1047951114001437 ◽

2014 ◽

Vol 25 (5) ◽

pp. 935-940 ◽

Cited By ~ 7

Author(s):

Brian Kogon ◽

Kim Woodall ◽

Kirk Kanter ◽

Bahaaldin Alsoufi ◽

Matt Oster

Keyword(s):

Risk Factors ◽

Hospital Stay ◽

Congenital Heart ◽

Heart Surgery ◽

Failure To Thrive ◽

Congenital Heart Surgery ◽

Cardiothoracic Surgery ◽

Hispanic Ethnicity ◽

Multivariate Risk ◽

Initial Hospital

AbstractBackground: We have previously identified risk factors for readmission following congenital heart surgery – Hispanic ethnicity, failure to thrive, and original hospital stay more than 10 days. As part of a quality initiative, changes were made to the discharge process in hopes of reducing the impact. All discharges were carried out with an interpreter, medications were delivered to the hospital before discharge, and phone calls were made to families within 72 hours following discharge. We hypothesised that these changes would decrease readmissions. Methods: The current cohort of 635 patients underwent surgery in 2012. Demographic, preoperative, operative, and postoperative variables were evaluated. Univariate and multivariate risk factor analyses were performed. Comparisons were made between the initial (2009) and the current (2012) cohorts. Results: There were 86 readmissions of 77 patients during 2012. Multivariate risk factors for readmission were risk adjustment for congenital heart surgery score and initial hospital stay >10 days. In comparing 2009 with 2012, the overall readmission rate was similar (10 versus 12%, p=0.27). Although there were slight decreases in the 2012 readmissions for those patients with Hispanic ethnicity (18 versus 16%, p=0.79), failure to thrive (23 versus 17%, p=0.49), and initial hospital stay >10 days (22 versus 20%, p=0.63), they were not statistically significant. Conclusions: Potential risk factors for readmission following paediatric cardiothoracic surgery have been identified. Although targeted modifications in discharge processes can be made, they may not reduce readmissions. Efforts should continue to identify modifiable factors that can reduce the negative impact of hospital readmissions.

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Mental well-being of patients from ethnic minority groups during critical care: a qualitative ethnographic study

BMJ Open ◽

10.1136/bmjopen-2016-014075 ◽

2017 ◽

Vol 7 (9) ◽

pp. e014075 ◽

Cited By ~ 4

Author(s):

Rose Lima Van Keer ◽

Reginald Deschepper ◽

Luc Huyghens ◽

Johan Bilsen

Keyword(s):

Mental Health ◽

Risk Factors ◽

Critical Care ◽

Ethnic Minority ◽

Healthcare Professionals ◽

Minority Groups ◽

Mental Health Problems ◽

Well Being ◽

Ethnic Minority Groups ◽

Mental Well Being

ObjectivesTo investigate the state of the mental well-being of patients from ethnic minority groups and possible related risk factors for the development of mental health problems among these patients during critical medical situations in hospital.DesignQualitative ethnographic design.SettingOneintensive care unit (ICU) of a multiethnic urban hospital in Belgium.Participants84 ICU staff members, 10 patients from ethnic-minority groups and their visiting family members.ResultsPatients had several human basic needs for which they could not sufficiently turn to anybody, neither to their healthcare professionals, nor to their relatives nor to other patients. These needs included the need for social contact, the need to increase comfort and alleviate pain, the need to express desperation and participate in end-of-life decision making. Three interrelated risk factors for the development of mental health problems among the patients included were identified: First, healthcare professionals’ mainly biomedical care approach (eg, focus on curing the patient, limited psychosocial support), second, the ICU context (eg, time pressure, uncertainty, regulatory frameworks) and third, patients’ different ethnocultural background (eg, religious and phenotypical differences).ConclusionsThe mental state of patients from ethnic minority groups during critical care is characterised by extreme emotional loneliness. It is important that staff should identify and meet patients’ unique basic needs in good time with regard to their mental well-being, taking into account important threats related to their own mainly biomedical approach to care, the ICU’s structural context as well as the patients’ different ethnocultural background.

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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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Junctional Ectopic Tachycardia: Recognition and Modern Management Strategies

Critical Care Nurse ◽

10.4037/ccn2020793 ◽

2020 ◽

Vol 40 (1) ◽

pp. 46-55

Author(s):

Kirsti G. Catton ◽

Jennifer K. Peterson

Keyword(s):

Risk Factors ◽

Congenital Heart ◽

Heart Surgery ◽

Early Recognition ◽

Treatment Options ◽

Age Groups ◽

Atrioventricular Node ◽

Congenital Heart Surgery ◽

Junctional Ectopic Tachycardia ◽

Perioperative Morbidity

Junctional ectopic tachycardia is a common dysrhythmia after congenital heart surgery that is associated with increased perioperative morbidity and mortality. Risk factors for development of junctional ectopic tachycardia include young age (neonatal and infant age groups); hypomagnesemia; higher-complexity surgical procedure, especially near the atrioventricular node or His bundle; and use of exogenous catecholamines such as dopamine and epinephrine. Critical care nurses play a vital role in early recognition of dysrhythmias after congenital heart surgery, assessment of hemodynamics affecting cardiac output, and monitoring the effects of antiarrhythmic therapy. This article reviews the underlying mechanisms of junctional ectopic tachycardia, incidence and risk factors, and treatment options. Currently, amiodarone is the pharmacological treatment of choice, with dexmedetomidine increasingly used because of its anti-arrhythmic properties and sedative effect.

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Risk factors for chylothorax and persistent serous effusions after congenital heart surgery

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz203 ◽

2019 ◽

Vol 56 (6) ◽

pp. 1162-1169 ◽

Cited By ~ 2

Author(s):

Anna Raatz ◽

Martin Schöber ◽

Robert Zant ◽

Robert Cesnjevar ◽

André Rüffer ◽

...

Keyword(s):

Risk Factors ◽

Heart Surgery ◽

Venous Pressure ◽

Congenital Heart Surgery ◽

Central Venous ◽

Aortic Cross Clamp Time ◽

Aortic Cross Clamp ◽

Assist Device ◽

Inotropic Score ◽

Vasoactive Inotropic Score

Abstract OBJECTIVES This study evaluated the various risk factors for chylothorax and persistent serous effusions (>7 days) after congenital heart surgery and developed equations to calculate the probability of their occurrence. METHODS We performed a retrospective review of different medical databases at the University Hospital of Erlangen between January 2014 and December 2016. Full model regression analysis was used to identify risk factors, and prediction algorithms were set up to calculate probabilities. Discriminative power of the models was checked with the help of C-statistics. RESULTS Of 745 operations on 667 patients, 68 chylothoraxes (9.1%) and 125 persistent pleural effusions (16.8%) were diagnosed. Lowest temperature [P = 0.043; odds ratio (OR) 0.899], trisomy 21 (P = 0.001; OR 5.548), a higher vasoactive inotropic score on the day of surgery (P = 0.001; OR 1.070) and use of an assist device (P = 0.001; OR 5.779) were significantly associated with chylothorax. Risk factors for persistent serous effusions were a given or possible involvement of the aortic arch during the operation (P = 0.000; OR 3.982 and 2.905), univentricular hearts (P = 0.019; OR 2.644), a higher number of previous heart operations (P = 0.014; OR 1.436), a higher vasoactive inotropic score 72 h after surgery (P = 0.019; OR 1.091), a higher central venous pressure directly after surgery (P = 0.046; OR 1.076) and an aortic cross-clamp time >86 min (P = 0.023; OR 2.223), as well as use of an assist device (P = 0.002; OR 10.281). The prediction models for both types of effusions proved to have excellent discriminative power. CONCLUSIONS Persistent serous effusion is associated with a higher vasoactive inotropic score 72 h after surgery, an aortic cross-clamp time >86 min and elevated central venous pressure directly after surgery, which, in combination, potentially indicate cardiac stress. The developed logistic algorithm helps to estimate future likelihood.

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Beyond 30 Days: Analysis of Unplanned Readmissions During the First Year Following Congenital Heart Surgery

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119895212 ◽

2020 ◽

Vol 11 (2) ◽

pp. 177-182 ◽

Cited By ~ 1

Author(s):

Entela B. Lushaj ◽

Joshua Hermsen ◽

Glen Leverson ◽

Susan G. MacLellan-Tobert ◽

Kari Nelson ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Congenital Heart ◽

Heart Surgery ◽

Hospital Readmissions ◽

Congenital Heart Surgery ◽

First Year ◽

Term Survival ◽

Viral Illness ◽

First 90 Days

Objective: We investigated the incidence and etiologies for unplanned hospital readmissions during the first year following congenital heart surgery (CHS) at our institution and the potential association of readmissions with longer term survival. Methods: We retrospectively reviewed 263 patients undergoing CHS at our institution from August 2011 to June 2015. Scheduled readmissions were excluded. Results: Seventy patients accrued a total of 120 readmissions (1.7 readmission/patient) within one year after surgery. The first readmission for 57% of the patients was within 30 days postdischarge. Twenty-two patients were first readmitted between 31 and 90 days postdischarge. Eight patients were first readmitted between 90 days and 1 year postdischarge. Median time-to-first readmission was 21 days. Median hospital length of stay at readmission was two days. Causes of 30-day readmissions included viral illness (25%), wound infections (15%), and cardiac causes (15%). Readmissions between 30 and 90 days included viral illness (27%), gastrointestinal (27%), and cardiac causes (9%). Age, STAT category, length of surgery, intubation, intensive care unit, and hospital stay were risk factors associated with readmissions based on logistic regression. Distance to hospital had a significant effect on readmissions ( P < .001). Patients with higher family income were less likely to be readmitted ( P < .001). There was no difference in survival between readmitted and non-readmitted patients ( P = .68). Conclusions: The first 90 days is a high-risk period for unplanned hospital readmissions after CHS. Complicated postoperative course, higher surgical complexity, and lower socioeconomic status are risk factors for unplanned readmissions the first 90 days after surgery. Efforts to improve the incidence or readmission after CHS should extend to the first 3 months after surgery and target these high-risk patient populations.

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