Implementation of a novel vocal cord dysfunction management pathway using the consolidated framework for implementation research

Abstract

Every year in Australia over a thousand children who are born with congenital heart disease require surgical intervention. Vocal cord dysfunction (VCD) can be an unavoidable and potentially devastating complication of surgery for congenital heart disease. Structured, multidisciplinary care pathways help to guide clinical care and reduce mortality and morbidity. An implementation study was conducted to embed a novel, multidisciplinary management pathway into practice using the consolidated framework for implementation research (CFIR). The goal of the pathway was to prepare children with postoperative vocal cord dysfunction to safely commence and transition to oral feeding. Education sessions to support pathway rollout were completed with clinical stakeholders. Other implementation strategies used included adaptation of the pre-procedural pathway to obtain consent, improving the process of identifying patients on the VCD pathway, and nominating a small team who were responsible for the ongoing monitoring of patients following recruitment. Implementation success was evaluated according to compliance with pathway defined management. Our study found that while there were several barriers to pathway adoption, implementation of the pathway was feasible despite pathway adaptations that were required in response to COVID-19.

Vocal cord dysfunction after pediatric cardiac surgery: A prospective implementation study

“…Detailed research methods and implementation protocol have been described previously. 14 Our aims included simultaneous implementation of a robust and clear clinical pathway for at-risk children using the principles of implementation science and the Consolidated Framework for Implementation Research and guided by an implementation expert (G.M.). 15 , 16 , 17 The clinical pathway ( Figure 1 ) was designed and implemented by a team involving cardiac and ear, nose, throat (ENT) surgery, radiology, speech pathology, dietetics, cardiology, and nursing staff.…”

“…Speech pathology assessment and laryngeal ultrasound combined was reliable for diagnosis in most patients and was more patient friendly than flexible direct laryngoscopy. (JTCVS Open 2022;-: [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Laryngeal ultrasound reliably demonstrates abduction and adduction of the vocal cords.…”

Evaluation of interdisciplinary care pathway implementation in older elective surgery patients

“…In an increasingly competitive healthcare landscape, distinction (e.g., Institute for Health Improvement Age-Friendly and ACS GSV designations) among peer institutions may incentivize investment in necessary resources to support patient-centered initiatives. [29][30][31][32] Our study has several limitations. First, we sampled purposively and interviewed until saturation was reached within each clinician role, yet participant responses may not represent all possible views on the intervention or be generalizable beyond the experiences at our institution.…”

“…Our institution has been compiling compliance data on frailty screening and interdisciplinary care pathway components for ongoing performance measurement and monitoring, anticipating reporting requirements. In an increasingly competitive healthcare landscape, distinction (e.g., Institute for Health Improvement Age‐Friendly and ACS GSV designations) among peer institutions may incentivize investment in necessary resources to support patient‐centered initiatives 29–32 …”