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. 2010 Apr;1(1):8-14.
doi: 10.1177/2150135109360915.

Variation in models of care delivery for children undergoing congenital heart surgery in the United States

Danielle S Burstein  1 , Anthony F Rossi, Jeffrey P Jacobs, Paul A Checchia, Gil Wernovsky, Jennifer S Li, Sara K Pasquali
Affiliations

Variation in models of care delivery for children undergoing congenital heart surgery in the United States

Danielle S Burstein et al. World J Pediatr Congenit Heart Surg. 2010 Apr.

Abstract

Limited data are available regarding contemporary models of care delivery for patients undergoing congenital heart surgery. The purpose of this survey was to evaluate current US practice patterns in this patient population. Cross-sectional evaluation of US centers caring for patients undergoing congenital heart surgery was performed using an Internet-based survey. Data regarding postoperative care were collected and described overall and were compared in centers with a pediatric intensive care unit (PICU) versus dedicated pediatric cardiac intensive care unit (CICU). A total of 94 (77%) of the estimated 122 US centers performing congenital heart surgery participated in the survey. The majority (79%) of centers were affiliated with a university. Approximately half were located in a free-standing children's hospital and half in a children's hospital in a hospital. Fifty-five percent provided care in a PICU versus a CICU. A combination of cardiologists and/or critical care physicians made up the largest proportion of physicians primarily responsible for postoperative care. Trainee involvement most often included critical care fellows (53%), pediatric residents (53%), and cardiology fellows (47%). Many centers (76%) also used physician extenders. In centers with a CICU, there was greater involvement of cardiologists and physicians with dual training (cardiology and critical care), fellows versus residents, and physician extenders. Results of this survey demonstrate variation in current models of care delivery used in patients undergoing congenital heart surgery in the United States. Further study is necessary to evaluate the implications of this variability on quality of care and patient outcomes.

Keywords: congenital heart surgery; health policy; intensive care.

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Figures

Figure 1
Figure 1
Center Region. NE = Northeast, SE = Southeast, SW = Southwest, NW = Northwest, MW = Midwest, and W = West
Figure 2
Figure 2
Center Affiliation.
Figure 3
Figure 3
Center Type.
Figure 4
Figure 4
Type of Intensive Care Unit. PICU = pediatric intensive care unit, CICU = pediatric cardiac intensive care unit
Figure 5
Figure 5
Primary Responsibility for Post-operative Care. *without critical care involvement, **without cardiology involvement
Figure 6
Figure 6
Trainees and Physician Extenders involved in Post-operative Care. CICU = cardiac intensive care unit, NP = nurse practitioner, PA = physician assistant
See this image and copyright information in PMC

References

    1. Boneva RS, Botto LD, Moore CA, Yang Q, Correa A, Erickson JD. Mortality associated with congenital heart defects in the United States: trends and racial disparities, 1979-1997. Circulation. 2001;103:2376–81. - PubMed
    1. Checchia PA, Bronicki RA, Costello JM, Nelson DP. Steroid use before pediatric cardiac operations using cardiopulmonary bypass: An international survey of 36 centers. Pediatr Crit Care Med. 2005;6:441–4. - PubMed
    1. Johnson JN, Jaggers J, Li JS, et al. Center variation and outcomes associated with delayed sternal closure following stage 1 palliation for hypoplastic left heart syndrome. Congenit Heart Dis. 2009;4:401. - PMC - PubMed
    1. Jaquiss RD, Ghanayem NS, Hoffman GM, et al. Early cavopulmonary anastomosis in very young infants after the Norwood procedure: impact on oxygenation, resource utilization, and mortality. J Thorac Cardiovasc Surg. 2004;127:982–9. - PubMed
    1. Kogon BE, Plattner C, Leong T, Simsic J, Kirshbom PM, Kanter KR. The bidirectional Glenn operation: a risk factor analysis for morbidity and mortality. J Thorac Cardiovasc Surg. 2008;136:1237–42. - PubMed

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