A Novel Nesting Protocol to Decrease Readmission and Increase Patient Satisfaction Following Congenital Heart Surgery.

BACKGROUND

Pediatric patients post-cardiac surgery have complex care needs requiring extensive discharge education and skill competency by caregivers to transition from the hospital environment to a medical home. The purpose of this quality improvement project was to implement a nesting protocol in the cardiovascular intensive care unit (CVICU) to improve discharge teaching and care coordination, with a goal to reduce readmission rates and increase caregiver satisfaction and understanding.

METHODS

A nesting protocol was created to provide clear and consistent guidelines to the multidisciplinary team. Pre- and post-intervention data was collected from caregiver satisfaction surveys, using a Likert scale, to determine understanding of nesting and feeling of preparedness upon discharge. In 2016 and 2017, retrospective chart reviews were performed to evaluate readmission data. SQUIRE 2.0 guidelines were utilized when writing this article (Ogrinc et al., 2015).

RESULTS

Caregivers reported an increase in satisfaction and understanding of the nesting process post-intervention with an increase of 4.48%. Readmission rates did not improve from 2016 to 2017. However, only 6 months of 2017 were reviewed.

CONCLUSIONS

Readmission is a significant problem for children with complex CHD. Post-discharge care requires caregivers to understand the medical care that their children require. Pre-intervention data revealed deficiencies in understanding regarding care regimens, infection control, and nutrition, which correlated with the most frequent causes for readmission among this population. The protocol developed addressed multiple issues concerning discharge readiness.