Ehrmann Daniel E, Harendt Shaunda, Church Jessica, Stimmler Amy, Vichayavilas Piyagarnt, Batz Sanja, Rodgers Jennifer, DiMaria Michael, Barrett Cindy, Kaufman Jon
Department of Pediatrics, The Heart Institute at Children's Hospital Colorado, Aurora, Colo.; Department of Audiology, Speech Pathology, & Learning Services, Children's Hospital Colorado, Aurora, Colo. Department of Clinical Nutrition, Children's Hospital Colorado, Aurora, Colo.; and Department of Occupational Therapy, Children's Hospital Colorado, Aurora, Colo.
Pediatr Qual Saf. 2017 Sep 28;2(5):e042. doi: 10.1097/pq9.0000000000000042. eCollection 2017 Sep-Oct.
Variable compliance to postoperative feeding algorithms after pediatric cardiac surgery may be associated with suboptimal growth, decreased parental satisfaction, and prolonged hospital length of stay (LOS). Our heart center performed an audit of compliance to a previously introduced postoperative feeding algorithm to guide quality improvement efforts. We hypothesized that algorithm noncompliance would be associated with increased LOS.
We retrospectively identified children ≤ 3 months admitted for their first cardiac surgery between January 1, 2015 and December 31, 2016. The algorithm uses objective oral feeding readiness assessments (FRA). At the end of a predefined evaluation period, a "sentinel" FRA score is assigned. The sentinel FRA and FRA trend guide decisions to pursue gastrostomy tube (GT) or oral-only feeds. Among those who reached the sentinel FRA, we defined compliance as ≤ 3 days before pursuing GT or oral-only feeds once indicated by the algorithm.
Sixty-nine patients were included. Forty-nine complied with the algorithm (71%), and 45 received GT (65.2%). Noncompliers had significantly longer LOS (34 versus 25 days; = 0.01). Among GT recipients, noncompliers waited 6 additional days for a GT compared with compliers ( ≤ 0.001). Subjective decisions to extend oral feeding trials or await results of a swallow study were associated with algorithm noncompliance.
This audit of compliance to a feeding algorithm after pediatric cardiac surgery highlighted variability of practice, including relying on subjective appraisals of feeding skills over objective FRAs. This variability was associated with increased LOS and can be hypothesis-generating for future quality improvement efforts.
小儿心脏手术后对术后喂养方案的依从性各异，这可能与生长发育欠佳、家长满意度降低以及住院时间延长有关。我们心脏中心对之前引入的术后喂养方案的依从性进行了审查，以指导质量改进工作。我们假设方案不依从会与住院时间延长相关。
我们回顾性纳入了2015年1月1日至2016年12月31日期间因首次心脏手术入院的3个月及以下儿童。该方案采用客观的经口喂养准备情况评估（FRA）。在预定义的评估期结束时，会给出一个“哨兵”FRA评分。“哨兵”FRA和FRA趋势指导关于是否采用胃造口管（GT）或仅经口喂养的决策。在达到“哨兵”FRA的患者中，我们将依从性定义为在方案指示采用GT或仅经口喂养后≤3天内执行。
共纳入69例患者。49例（71%）依从方案，45例（65.2%）接受了GT。不依从者的住院时间显著更长（34天对25天；P = 0.01）。在接受GT的患者中，不依从者比依从者等待GT的时间多6天（P≤0.001）。延长经口喂养试验或等待吞咽研究结果的主观决策与方案不依从相关。
此次小儿心脏手术后对喂养方案依从性的审查突出了实践的差异性，包括依赖于对喂养技能的主观评估而非客观的FRA。这种差异性与住院时间延长相关，可为未来的质量改进工作提供假设依据。
