Voluntary Implementation of Critical Congenital Heart Disease Screening in Washington Hospitals

Abstract

OBJECTIVES:To determine the extent of voluntary implementation of pulse oximetry screening for critical congenital heart disease (CCHD) in Washington. At the time of the study, there was no state legislative or regulatory mandate for CCHD screening in Washington. METHODS:A Web-based survey was sent to the nurse manager or nurse educator of the well newborn unit at each of the 64 Washington hospitals with active delivery services in May and June 2013. Telephone follow-up was conducted for incomplete surveys. The survey assessed awareness and implementation of the recommendation, the protocol followed, staffi ng and equipment issues, pediatric cardiology support services, and the availability of prostaglandin E 1 at each birth hospital. A brief follow-up was performed in December 2013 for hospitals not screening at the time of the initial survey. RESULTS:As of December 2013, 89% of Washington birth hospitals (accounting for 91.4% of births) had active CCHD screening programs. The recommended protocol is used in 95% of screening hospitals. Screening programs were instituted in 96% of hospitals using existing staff, but 52% of hospitals purchased new durable equipment to institute screening. CONCLUSIONS:There has been widespread voluntary adoption of pulse oximetry screening for CCHD in Washington birth hospitals. Quality assurance efforts are needed to assess the quality of the screening programs.

Critical Congenital Heart Disease Screening Practices Among Licensed Midwives in Washington State

“…Interestingly, the screening midwife subset reported better compliance (94%) than hospitals in Washington state with screening in the recommended window between 24 and 48 hours of life. Other work by our group found that 13% of Washington hospitals reported most commonly screening newborns between 12 and 24 hours after vaginal birth, a window of time associated with increased incidence of false‐positive screens . One hypothesis is that midwife providers are able to better adhere to a screening goal between 24 and 48 hours of life due to a previously established practice of a follow‐up visit (either home or office) in this window and the absence of parental pressure for a day‐of‐life‐one discharge.…”

“…However, LM implementation of CCHD screening in out‐of‐hospital births in Washington state is lagging behind hospital implementation. Currently, 89% of Washington birth hospitals have universal screening protocols in place, whereas only approximately half of midwives who responded to this survey are currently screening. A high proportion of respondents agree in principle with the concept of pulse oximetry screening; only 10% of respondents indicated they do not plan to implement screening.…”

Pulse oximetry screening: a review of diagnosing critical congenital heart disease in newborns

“…Many states that have initiated pulse oximetry screening have adapted this protocol or a variation there of. 12 , 13 , 15 Kochilas et al 14 demonstrated that the SACHDNC protocol was the most efficient protocol with the fewest false-positive pulse oximetry screens in the newborn period. Data from various studies suggest that this protocol is adequate to detect clinical and subclinical hypoxemia that is associated with the seven primary target lesions based on their almost universal association with at least mild hypoxemia in the neonatal period, when the fetal circulation transitions to postnatal circulation.…”

“… 11 In the subsequent years, many states have implemented their own protocols to comply with this recommendation. 12 – 15 …”

Infants born with critical CHD in Arizona and capacities of birth centres for screening and management

“…5 Reviews of individual state implementation have been reported for only a few states, including Wisconsin, 6 Georgia, 7 Minnesota, 8 and Washington. 9 Fetal echocardiography is the gold standard for diagnosing critical CHD prenatally. In a review of screening practices at Boston Children's Hospital, the pulse-oximetry programme discovered no new diagnoses of critical CHD that had not been diagnosed through fetal echocardiography 10 ; however, in rural settings where echocardiography is less likely to be available because of high costs and limited access to paediatric cardiologists, pulse oximetry may effectively detect undiagnosed critical CHD in newborns.…”