High Acuity Therapy Variation Across Pediatric Acute Care Cardiology Units: Results from the Pediatric Acute Care Cardiology Collaborative Hospital Surveys

Ashraf S Harahsheh¹, Alaina K Kipps², Stephen A Hart³, Steven C Cassidy³, Martha L Clabby⁴, Anthony M Hlavacek⁵, Amanda K Hoerst⁶, Margaret A Graupe⁶, Nicolas L Madsen^{6

7}, Adnan M Bakar⁸, Erica L Del Grippo⁹, Sonali S Patel¹⁰, James E Bost¹¹, Ronn E Tanel¹²; Pediatric Acute Care Cardiology Collaborative (PAC3)

Affiliations

¹ Division of Cardiology, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine & Health Sciences, 111 Michigan Ave, NW, Washington, DC, 20010, USA. aharahsh@childrensnational.org.
² Division of Cardiology, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA, USA.
³ Division of Cardiology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
⁴ Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.
⁵ Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
⁶ Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁷ Division of Pediatric Cardiology, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
⁸ Division of Critical Care Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA.
⁹ Nemours Cardiac Center at A.I. duPont Hospital for Children, Wilmington, DE, USA.
¹⁰ Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.
¹¹ Division of Biostatistics and Study Methodology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
¹² Division of Pediatric Cardiology, Department of Pediatrics, UCSF Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA, USA.

PMID: 33813599
PMCID: PMC8019478
DOI: 10.1007/s00246-021-02584-3

Multicenter Study

High Acuity Therapy Variation Across Pediatric Acute Care Cardiology Units: Results from the Pediatric Acute Care Cardiology Collaborative Hospital Surveys

Ashraf S Harahsheh et al. Pediatr Cardiol. 2021 Jun.

. 2021 Jun;42(5):1074-1081.

doi: 10.1007/s00246-021-02584-3. Epub 2021 Apr 4.

Authors

Affiliations

¹ Division of Cardiology, Department of Pediatrics, Children's National Hospital, George Washington University School of Medicine & Health Sciences, 111 Michigan Ave, NW, Washington, DC, 20010, USA. aharahsh@childrensnational.org.
² Division of Cardiology, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA, USA.
³ Division of Cardiology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
⁴ Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.
⁵ Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
⁶ Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁷ Division of Pediatric Cardiology, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
⁸ Division of Critical Care Medicine, Department of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA.
⁹ Nemours Cardiac Center at A.I. duPont Hospital for Children, Wilmington, DE, USA.
¹⁰ Department of Pediatrics, Section of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.
¹¹ Division of Biostatistics and Study Methodology, Children's National Hospital, George Washington University School of Medicine, Washington, DC, USA.
¹² Division of Pediatric Cardiology, Department of Pediatrics, UCSF Benioff Children's Hospital, UCSF School of Medicine, San Francisco, CA, USA.

PMID: 33813599
PMCID: PMC8019478
DOI: 10.1007/s00246-021-02584-3

Abstract

We utilized the multicenter Pediatric Acute Care Cardiology Collaborative (PAC³) 2017 and 2019 surveys to describe practice variation in therapy availability and changes over a 2-year period. A high acuity therapies (ATs) score was derived (1 point per positive response) from 44 survey questions and scores were compared to center surgical volume. Of 31 centers that completed the 2017 survey, 26 also completed the 2019 survey. Scores ranged from 11 to 34 in 2017 and 11 to 35 in 2019. AT scores in 2019 were not statistically different from 2017 scores (29/44, IQR 27-32.5 vs. 29.5/44, IQR 27-31, p = 0.9). In 2019, more centers reported initiation of continuous positive airway pressure (CPAP) and Bi-level positive airway pressure (BiPAP) in Acute Care Cardiology Unit (ACCU) (19/26 vs. 4/26, p < 0.001) and permitting continuous CPAP/BiPAP (22/26 vs. 14/26, p = 0.034) compared to 2017. Scores in both survey years were significantly higher in the highest surgical volume group compared to the lowest, 33 ± 1.5 versus 25 ± 8.5, p = 0.046 and 32 ± 1.7 versus 23 ± 5.5, p = 0.009, respectively. Variation in therapy within the ACCUs participating in PAC³ presents an opportunity for shared learning across the collaborative. Experience with PAC³ was associated with increasing available respiratory therapies from 2017 to 2019. Whether AT scores impact the quality and outcomes of pediatric acute cardiac care will be the subject of further investigation using a comprehensive registry launched in early 2019.

Keywords: Congenital heart disease; Hospitalist medicine; Inpatient cardiology; Pediatric Acute Care Cardiology Collaborative (PAC3); Pediatric cardiology.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflict of interest relevant to this article to disclose.

Figures

**Fig. 1**
Number of Centers included in this study

**Fig. 2**
2017 High acuity therapies (ATs) scores. AT high acuity therapy

**Fig. 3**
High acuity therapies (ATs) across member institutions as a function of surgical volume. ^#Significant difference (p = 0.009) was noted between the highest and lowest surgical volume groups for 2017 AT score. *Significant difference (p = 0.046) was noted between the highest and lowest surgical volume groups for 2019 AT score. AT high acuity therapy

See this image and copyright information in PMC

References

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High Acuity Therapy Variation Across Pediatric Acute Care Cardiology Units: Results from the Pediatric Acute Care Cardiology Collaborative Hospital Surveys

Affiliations

High Acuity Therapy Variation Across Pediatric Acute Care Cardiology Units: Results from the Pediatric Acute Care Cardiology Collaborative Hospital Surveys

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical