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组建用于单心室心脏缺陷纵向护理的综合团队:基石与初步成果。

Building a comprehensive team for the longitudinal care of single ventricle heart defects: Building blocks and initial results.

作者信息

Texter Karen, Davis Jo Ann M, Phelps Christina, Cheatham Sharon, Cheatham John, Galantowicz Mark, Feltes Timothy F

机构信息

Division of Cardiology, Nationwide Children's Hospital, Columbus, Ohio, USA.

Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.

出版信息

Congenit Heart Dis. 2017 Jul;12(4):403-410. doi: 10.1111/chd.12459. Epub 2017 Jul 26.

Abstract

INTRODUCTION

With increasing survival of children with HLHS and other single ventricle lesions, the complexity of medical care for these patients is substantial. Establishing and adhering to best practice models may improve outcome, but requires careful coordination and monitoring.

METHODS

In 2013 our Heart Center began a process to build a comprehensive Single Ventricle Team designed to target these difficult issues.

RESULTS

Comprehensive Single Ventricle Team in 2014 was begun, to standardize care for children with single ventricle heart defects from diagnosis to adulthood within our institution. The team is a multidisciplinary group of providers committed to improving outcomes and quality of life for children with single ventricle heart defects, all functioning within the medical home of our heart center. Standards of care were developed and implemented in five target areas to standardize medical management and patient and family support. Under the team 100 patients have been cared for. Since 2014 a decrease in interstage mortality for HLHS were seen. Using a team approach and the tools of Quality Improvement they have been successful in reaching high protocol compliance for each of these areas.

CONCLUSIONS

This article describes the process of building a successful Single Ventricle team, our initial results, and lessons learned. Additional study is ongoing to demonstrate the effects of these interventions on patient outcomes.

摘要

引言

随着左心发育不全综合征(HLHS)及其他单心室病变患儿存活率的提高,这些患者的医疗护理复杂性显著增加。建立并遵循最佳实践模式可能会改善治疗结果,但需要仔细的协调和监测。

方法

2013年,我们的心脏中心开始着手组建一个全面的单心室团队,旨在解决这些难题。

结果

2014年全面的单心室团队成立,以规范本机构内单心室心脏缺陷患儿从诊断到成年期的护理。该团队是一个多学科的医疗服务提供者群体,致力于改善单心室心脏缺陷患儿的治疗结果和生活质量,所有成员都在我们心脏中心的医疗之家内开展工作。在五个目标领域制定并实施了护理标准,以规范医疗管理以及对患者和家庭的支持。在该团队的护理下,已有100名患者得到照料。自2014年以来,HLHS患者的阶段间死亡率有所下降。通过采用团队方法和质量改进工具,他们成功地在这些领域中的每一个都实现了较高的方案依从性。

结论

本文描述了建立一个成功的单心室团队的过程、我们的初步结果以及所吸取的经验教训。正在进行进一步研究以证明这些干预措施对患者治疗结果的影响。

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