Faculty Collaboration Database

Home monitoring program reduces interstage mortality after the modified Norwood procedure. J Thorac Cardiovasc Surg 2014 Feb;147(2):718-23.e1

Date

05/15/2013

Pubmed ID

23663957

DOI

10.1016/j.jtcvs.2013.04.006

Scopus ID

2-s2.0-84892367249 (requires institutional sign-in at Scopus site)   62 Citations

Abstract

BACKGROUND: From 2002 to 2005, the interstage mortality after a modified Norwood procedure was 7% in our program. An interstage home monitoring program (HMP) was established to identify Norwood procedure patients at increased risk of decompensation and to reduce interstage mortality.

METHODS: Results of the first 5 years of the Norwood HMP were reviewed retrospectively. Interstage was defined as the time between Norwood hospital discharge and admission for second stage surgical palliation. In the HMP, families documented oxygen saturation, heart rate, weight, and feedings daily. Nurse practitioners called each family at least weekly, and when issues arose, action plans were determined based on symptom severity.

RESULTS: Between October 2005 and October 2010 there were 46 Norwood procedure patients who survived to hospital discharge. All were enrolled in the HMP. Forty-five patients had a Norwood procedure with right ventricle to pulmonary artery conduit, and 1 patient had a modified Blalock-Taussig shunt. Interstage survival was 100%. Nineteen patients (41%) were admitted interstage; 5 patients were admitted twice, 1 patient was admitted 4 times. Seventeen patients (37%) required interstage interventions. Eight patients (17%) required major interventions: conduit stenting, aortic arch balloon angioplasty, emergent shunt, or early Glenn surgery. Minor interventions included supplemental oxygen, blood transfusion, intravenous hydration, diuresis, anti-arrhythmic therapy, or feeding adjustments.

CONCLUSIONS: In the first 5 years of the HMP, all infants discharged after a modified Norwood procedure survived the interstage period. The HMP altered clinical management in 37% of patients. Home monitoring of oxygen saturation, heart rate, weight, and feedings, along with comprehensive care coordination, allowed timely interventions and reduced interstage mortality from 7% to 0%.

Author List

Siehr SL, Norris JK, Bushnell JA, Ramamoorthy C, Reddy VM, Hanley FL, Wright GE

Author

Stephanie S. Handler MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Body Weight
Eating
Heart Defects, Congenital
Heart Failure
Heart Rate
Home Care Services, Hospital-Based
Humans
Infant
Infant Nutritional Physiological Phenomena
Infant, Newborn
Male
Norwood Procedures
Nurse Practitioners
Nutritional Status
Oxygen
Patient Discharge
Patient Readmission
Program Evaluation
Retrospective Studies
Risk Factors
Survival Analysis
Time Factors
Treatment Outcome