Open Access

ARTICLE

Variation in care practices across pediatric acute care cardiology units: Results of the Pediatric Acute Care Cardiology Collaborative (PAC³ ) hospital survey

Amanda Hoerst¹, Adnan Bakar², Steven C. Cassidy³, Martha Clabby⁴, Erica Del Grippo⁵, Margaret Graupe¹, Ashraf S. Harahsheh⁶, Anthony M. Hlavacek⁷, Stephen A. Hart³, Alaina K. Kipps⁸, Nicolas L. Madsen¹, Dora D. O’Neil⁹, Sonali S. Patel¹⁰, Courtney M. Strohacker¹¹, Ronn E. Tanel¹²

1 Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
2 Cohen’s Children’s Medical Center, Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
3 Nationwide Children’s Hospital, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
4 Children’s Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
5 Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
6 Children’s National Medical Center, Department of Pediatrics, The George Washington University School of Medicine, Washington, District of Columbia
7 MUSC Children’s Hospital, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
8 Lucile Packard Children’s Hospital, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
9 St. Louis Children’s Hospital, St. Louis, Missouri
10 Children’s Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
11 C. S. Mott Children’s Hospital, Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, Michigan
12 UCSF Benioff Children’s Hospital, Department of Pediatrics, UCSF School of Medicine, San Francisco, California

* Corresponding Author: Amanda Hoerst, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 11004, Cincinnati, OH 45229. Email:

Congenital Heart Disease 2019, 14(3), 419-426. https://doi.org/10.1111/chd.12739

Abstract

Background: The Pediatric Acute Care Cardiology Collaborative (PAC3) was estab‐ lished in 2014 to improve the quality, value, and experience of hospital‐based cardiac acute care outside of the intensive care unit. An initial PAC3 project was a compre‐ hensive survey to understand unit structure, practices, and resource utilization across the collaborative. This report aims to describe the previously unknown degree of practice variation across member institutions.
Methods: A 126‐stem question survey was developed with a total of 412 possible response fields across nine domains including demographics, staffing, available re‐ sources and therapies, and standard care practices. Five supplemental questions ad‐ dressed surgical case volume and number of cardiac acute care unit (CACU) admissions. Responses were recorded and stored in Research Electronic Data Capture (REDCap).
Results: Surveys were completed by 31 out of 34 centers (91%) with minimal incom‐ plete fields. A majority (61%) of centers have a single dedicated CACU, which is contiguous or adjacent to the intensive care unit in 48%. A nurse staffing ratio of 3:1 is most common (71%) and most(84%) centers employed a resource nurse. Centralized wireless rhythm monitoring is used in 84% of centers with 54% staffed continuously. There was significant variation in the use of noninvasive respiratory support, vasoac‐ tive infusions, and ventricular assist devices across the collaborative. Approximately half of the surveyed centers had lesion‐specific postoperative pathways and approxi‐ mately two‐thirds had protocols for single‐ventricle patients.
Conclusions: The PAC3 hospital survey is the most comprehensive description of sys‐ tems and care practices unique to CACUs to date. There exists considerable hetero‐ geneity among unit composition and variation in care practices. These variations may allow for identification of best practices and improved quality of care for patients.

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