Bingler Michael, Erickson Lori A, Reid Kimberly J, Lee Brian, O'Brien James, Apperson Johnathan, Goggin Kathy, Shirali Girish
1 Nemours Children's Hospital Orlando, Orlando, FL, USA.
2 Children's Mercy Kansas City, Kansas City, MO, USA.
World J Pediatr Congenit Heart Surg. 2018 May;9(3):305-314. doi: 10.1177/2150135118762401.
Interstage outcomes for infants with single ventricle remain suboptimal. We have previously described a tablet PC-based platform Cardiac High Acuity Monitoring Program (CHAMP) for remote monitoring which provides immediate access to data, videos, and instant alerts to our single ventricle care team.
This study compares traditional three-ring binder monitoring (Binder) to CHAMP using a randomized crossover design to evaluate mortality, resource utilization, and caregiver experience. At discharge, all single ventricle infants were monitored using Binder and randomized to receive CHAMP at either one or two months postdischarge. One month after randomization, caregivers could choose either Binder or CHAMP for the remainder of the interstage period. Caregivers experience was recorded using surveys.
Enrollment included 31 single ventricle infants from May 2014 to June 2015. There was no interstage mortality over 4,911 total interstage days (median: 144/patient). Of 73 readmissions, 45 were unplanned. Of the initial 23 unplanned readmissions, 13 were found to have been based on data obtained exclusively through CHAMP (as instant alerts or based on data review) rather than caregiver concerns. Due to concerns regarding patient safety, additional enrollment was stopped. The CHAMP use was associated with significantly fewer unplanned intensive care unit days/100 interstage days, shorter delays in care, lower resource utilization at readmissions, and lower incidence of interstage growth failure and was preferred by a majority of caregivers.
These findings suggest that CHAMP may offer benefits over Binder (improved interstage outcomes, delays in care, and caregiver experience). These findings should be tested across multiple centers in larger populations.
单心室婴儿的过渡期结局仍不尽人意。我们之前描述了一种基于平板电脑的平台——心脏重症监护监测程序（CHAMP）用于远程监测，该平台能让我们的单心室护理团队即时获取数据、视频并接收即时警报。
本研究采用随机交叉设计，将传统的三环活页夹监测（活页夹组）与CHAMP进行比较，以评估死亡率、资源利用情况和护理人员的体验。出院时，所有单心室婴儿均采用活页夹组进行监测，并随机分为在出院后1个月或2个月接受CHAMP。随机分组1个月后，护理人员可在过渡期剩余时间选择活页夹组或CHAMP。通过调查记录护理人员的体验。
2014年5月至2015年6月共纳入31名单心室婴儿。在总计4911个过渡期日（中位数：每位患者144天）内无过渡期死亡。73次再入院中，45次为非计划再入院。在最初的23次非计划再入院中，有13次被发现完全是基于通过CHAMP获取的数据（即时警报或基于数据审查），而非护理人员的担忧。由于对患者安全的担忧，停止了额外的入组。使用CHAMP与显著减少的非计划重症监护病房天数/100个过渡期日、更短的护理延迟、再入院时更低的资源利用以及更低的过渡期生长发育不良发生率相关，并且大多数护理人员更喜欢CHAMP。
这些发现表明，CHAMP可能比活页夹组更具优势（改善过渡期结局、减少护理延迟以及提升护理人员体验）。这些发现应在多个中心的更大人群中进行验证。
