Burstein Danielle S, Rossi Anthony F, Jacobs Jeffrey P, Checchia Paul A, Wernovsky Gil, Li Jennifer S, Pasquali Sara K
Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA.
World J Pediatr Congenit Heart Surg. 2010 Apr;1(1):8-14. doi: 10.1177/2150135109360915.
Limited data are available regarding contemporary models of care delivery for patients undergoing congenital heart surgery. The purpose of this survey was to evaluate current US practice patterns in this patient population. Cross-sectional evaluation of US centers caring for patients undergoing congenital heart surgery was performed using an Internet-based survey. Data regarding postoperative care were collected and described overall and were compared in centers with a pediatric intensive care unit (PICU) versus dedicated pediatric cardiac intensive care unit (CICU). A total of 94 (77%) of the estimated 122 US centers performing congenital heart surgery participated in the survey. The majority (79%) of centers were affiliated with a university. Approximately half were located in a free-standing children's hospital and half in a children's hospital in a hospital. Fifty-five percent provided care in a PICU versus a CICU. A combination of cardiologists and/or critical care physicians made up the largest proportion of physicians primarily responsible for postoperative care. Trainee involvement most often included critical care fellows (53%), pediatric residents (53%), and cardiology fellows (47%). Many centers (76%) also used physician extenders. In centers with a CICU, there was greater involvement of cardiologists and physicians with dual training (cardiology and critical care), fellows versus residents, and physician extenders. Results of this survey demonstrate variation in current models of care delivery used in patients undergoing congenital heart surgery in the United States. Further study is necessary to evaluate the implications of this variability on quality of care and patient outcomes.
关于接受先天性心脏手术患者的当代护理模式的可用数据有限。本次调查的目的是评估美国这一患者群体当前的实践模式。通过基于互联网的调查对美国为接受先天性心脏手术患者提供护理的中心进行横断面评估。收集并整体描述了术后护理的数据，并在设有儿科重症监护病房（PICU）和专门的儿科心脏重症监护病房（CICU）的中心之间进行了比较。在美国估计122家进行先天性心脏手术的中心中，共有94家（77%）参与了此次调查。大多数中心（79%）隶属于大学。大约一半位于独立儿童医院，另一半位于综合医院中的儿童医院。55%的中心在PICU而非CICU提供护理。心脏病专家和/或重症监护医生的组合构成了主要负责术后护理的医生的最大比例。实习生参与最常见的包括重症监护住院医师（53%）、儿科住院医师（53%）和心脏病学住院医师（47%）。许多中心（76%）也使用医生助理。在设有CICU的中心，心脏病专家和接受双重培训（心脏病学和重症监护）的医生、住院医师与实习医生以及医生助理的参与度更高。本次调查结果表明，美国接受先天性心脏手术患者目前使用的护理模式存在差异。有必要进行进一步研究以评估这种变异性对护理质量和患者预后的影响。
