Bedside Benchmarks: Transparent Data to Reduce Variation in Postoperative Care

HummelKevin,; White, Benjamin R; AlgazeClaudia, A; MarroneTighe,; SinnottJennifer, A; WawrzynskiSarah,; Winder, Melissa; BaillyDavid,

doi:10.1056/cat.21.0032

Cited by 2 publications

(2 citation statements)

References 22 publications

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“…Univariable and multivariable logistic regression models were fitted to the binary outcome variables “cardiovascular” and “feeding/fluid,” with generalised estimating equation method to account for correlation of outcomes within subjects. The models include the following clinical variables of interest: final ICU need (“cardiovascular,” “respiratory” or “other”), 5 benchmark operation, age, cardiac ICU and acute care unit length of stay, presence of genetic syndrome, post-operative complications (such as necrotising enterocolitis, extra-corporeal membrane oxygenation, ventricular assist device, or cardiac arrest), and discharge needs (provider, season, distance to home, and feeding/oxygen/narcotic weans). We used the generalised variance inflation factor to assess multicollinearity among covariates in our multivariable model settings.…”

Section: Methodsmentioning

confidence: 99%

“…These data have led to improvement efforts to reduce practice variation and improve clinical processes in that segment of care. 5 However, there is a gap in our knowledge in the final segment of hospital-based care for paediatric CHD patients or the Final Hospital Need. We defined the Final Hospital Need as the primary reason a patient required inpatient care in the 24 hours preceding their discharge.…”

Section: Introductionmentioning

confidence: 99%

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The final hospital need in children discharged from a cardiology acute care unit: a single-centre survey study

Ware

Reiter²,

Winder³

et al. 2022

Cardiol Young

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Objective: Children with heart disease may require inpatient care for many reasons, but ultimately have a final reason for hospitalisation prior to discharge. Factors influencing length of stay in paediatric cardiac acute care units have been described but the last reason for hospitalisation has not been studied. Our aim was to describe Final Hospital Need as a novel measure, determine Final Hospital Need in our patients, and describe factors associated with this Need. Methods: Single-centre survey design. Discharging providers selected a Final Hospital Need from the following categories: cardiovascular, respiratory, feeding/fluid, haematology/ID, pain/sedation, systems issues, and other/wound issues. Univariable and multivariable analyses were performed separately for outcomes “cardiovascular” and “feeding/fluid.” Measurements and Results: Survey response rate was 99% (624 encounters). The most frequent Final Hospital Needs were cardiovascular (36%), feeding/fluid (24%) and systems issues (13%). Probability of Final Hospital Need “cardiovascular” decreased as length of stay increased. Multivariate analysis showed Final Hospital Need “cardiovascular” was negatively associated with aortic arch repair, Norwood procedure, and Final ICU Need “respiratory” and “other.” Final Hospital Need "feeding/fluid” was negatively associated with left-sided valve procedure, but positively associated with final ICU need “respiratory,” and tube feeding at discharge. Conclusions: Final Hospital Need is a novel measure that can be predicted by clinical factors including age, Final ICU Need, and type of surgery. Final Hospital Need may be utilised to track changes in clinical care over time and as a target for improvement work.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%