Ligon R Allen, Bhombal Shazia, Adamson Marissa, Hash Sarah, Kim Dennis W, LeFevre Ashley S, Long Justin B, McLaughlin Sarah, Mills Marcos, Roddy Katie, Tucker Lucas, Samai Cyrus, Piazza Anthony, Hamrick Shannon E
Division of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, 2970 Brandywine Rd, Suite 125, Atlanta, GA, 30341, USA.
Division of Neonatology, Children's Healthcare of Atlanta, Emory University School of Medicine, 316 F 3rd Floor Emory Children's Center, Atlanta, GA, 30322, USA.
Pediatr Cardiol. 2024 Aug 28. doi: 10.1007/s00246-024-03629-z.
Outline a quality initiative establishing an institutional service line for neonatal transcatheter device closure of the patent ductus arteriosus (TDC-PDA). A retrospective descriptive observational study surrounds programmatic approach to TDC-PDA in premature neonates with process measure spanning education, implementation, referral, and post-procedural care. Metrics tracked pre- and post-program creation with statistical analyses performed. Neonatal TDC-PDA referrals increased exponentially since program inception (n = 13 in year prior; n = 42 year 1; n = 74 year 2), especially in patients weighing less than 1.3 kg (12.5%; 55%; 50%), and were associated with an increased procedural success rate (81%; 95%; 99%). Procedural checklist creation decreased procedural "out of isolette" time (median 93 min; 59; 52), and procedural-related complication or clinical sequelae (19%; 12%; 4%). A multidisciplinary service line and program dedicated to neonatal TDC-PDA can result in a significant increase in referrals as well as procedural efficacy and safety for this medically fragile population.
概述一项质量改进计划，该计划为新生儿动脉导管未闭经导管装置闭合术（TDC-PDA）建立机构服务线。一项回顾性描述性观察研究围绕对早产儿TDC-PDA的程序化方法展开，过程指标涵盖教育、实施、转诊和术后护理。在计划创建前后跟踪指标，并进行统计分析。自计划启动以来，新生儿TDC-PDA转诊呈指数级增长（前一年为13例；第1年为42例；第2年为74例），尤其是体重小于1.3千克的患者（分别为12.5%、55%、50%），且与手术成功率提高相关（分别为81%、95%、99%）。手术检查表的创建减少了手术“出暖箱”时间（中位数分别为93分钟、59分钟、52分钟）以及与手术相关的并发症或临床后遗症（分别为19%、12%、4%）。一个致力于新生儿TDC-PDA的多学科服务线和计划可以使转诊显著增加，并提高这一医疗脆弱人群的手术疗效和安全性。
