Natalie M. Hoeting¹, Courtney E. McCracken¹, Michael McConnell^1,2, Denver Sallee^1,2, Glen J. Iannucci^1,2, Matthew E. Oster^1,2

Congenital Heart Disease, Vol.12, No.4, pp. 417-420, 2017, DOI:10.1111/chd.12460

Abstract Objective: Bicuspid aortic valve (BAV) disease is associated with potential lifetime complications, but auscultation of a BAV click is commonly missed or mistaken for a benign split first heart sound. Our objective was to determine whether pediatric cardiologists could reliably distinguish between BAV clicks and benign split first heart sounds.
Design: Quality evaluation project using de-identified recordings from an outpatient pediatric cardiology clinic.
Outcome Measures: Twenty-one cardiologists listened to five de-identified recordings of pediatric heart sounds (three with BAV clicks, two with mitral components of benign split first heart sounds) and indicated whether they believed each recording was a BAV… More >

Karen Texter^1,2, Jo Ann M. Davis¹, Christina Phelps^1,2, Sharon Cheatham^1,2, John Cheatham^1,2, Mark Galantowicz^1,3, Timothy F. Feltes^1,2

Congenital Heart Disease, Vol.12, No.4, pp. 403-410, 2017, DOI:10.1111/chd.12459

Abstract Introduction: With increasing survival of children with HLHS and other single ventricle lesions, the complexity of medical care for these patients is substantial. Establishing and adhering to best practice models may improve outcome, but requires careful coordination and monitoring.
Methods: In 2013 our Heart Center began a process to build a comprehensive Single Ventricle Team designed to target these difficult issues.
Results: Comprehensive Single Ventricle Team in 2014 was begun, to standardize care for children with single ventricle heart defects from diagnosis to adulthood within our institution. The team is a multidisciplinary group of providers committed to improving outcomes and… More >

Ritu Sachdeva¹, Pamela S. Douglas², Michael S. Kelleman¹, Courtney E. McCracken¹, Leo Lopez³, Kenan W.D. Stern⁴, Benjamin W. Eidem⁵, Oscar J. Benavidez⁶, Rory B. Weiner⁶, Elizabeth Welch³, Robert M. Campbell¹, Wyman W. Lai⁷

Congenital Heart Disease, Vol.12, No.3, pp. 373-381, 2017, DOI:10.1111/chd.12455

Abstract Objective: The objective of this study was to evaluate effectiveness of educational intervention (EI) in the Pediatric Appropriate Use of Echocardiography (PAUSE) study to improve appropriateness of transthoracic echocardiograms (TTEs) ordered in pediatric cardiology clinics.
Design: Data were prospectively collected after the publication of the Appropriate Use Criteria (AUC) document during 2 phases: the pre-EI phase (1/1/15 to 4/30/15) and the post-EI phase (7/ 1/15 to 10/30/15). Pre-EI, site-investigators (SI) determined AUC indications, by reviewing the clinic records. Post-EI, providers assigned indications prior to obtaining TTE.
Setting: Pediatric cardiology clinics at six centers.
Patients: Those ≤18 years old, receiving initial… More >

Waldemar F. Carlo¹, James F. Cnota², Robert J. Dabal³, Jeffrey B. Anderson²

Congenital Heart Disease, Vol.12, No.3, pp. 315-321, 2017, DOI:10.1111/chd.12442

Abstract Objective: The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) was established in 2008 to improve outcomes of hypoplastic left heart syndrome (HLHS) during the interstage period. They evaluated changes in patient variables and practice variation between early and late eras.
Design: Data including demographic, operative, discharge, and follow-up variables from the first 100 patients (6/2008–1/2010) representing 18 centers were compared with the most recent 100 patients (1/2014–11/2014) from these same centers.
Results: Prenatal diagnosis increased from 69% to 82% (P = .05). There were no differences in gestational age or weight at Norwood. A composite of any preoperative risk factor… More >

Jeffrey H. Sacks^1,2, Michael Kelleman², Courtney McCracken², Michelle Glanville¹, Matthew Oster^1,2

Congenital Heart Disease, Vol.12, No.3, pp. 282-288, 2017, DOI:10.1111/chd.12436

Abstract Objective: Hospital readmissions are increasingly becoming a metric for quality in the current landscape of changing and cost effective medicine. However, no 30-d readmission rates have been established for pediatric cardiac medical patients in the United States. Thus, the objective was to determine 30 d readmission rates and risk factors associated with readmission for pediatric cardiac patients, hypothesizing that pediatric cardiac patients would have significantly higher readmission rates than their general pediatric counterparts.
Design: This was a retrospective cohort study.
Setting: The study took place at a large urban academic children’s hospital.
Patients: The 1124 included patients were discharged from… More >

Janet M. Simsic, Kirby-Rose Carpenito, Kristin Kirchner, Stephanie Peters, PNP-AC, Holly Miller-Tate, Brian Joy, Mark Galantowicz

Congenital Heart Disease, Vol.12, No.3, pp. 275-281, 2017, DOI:10.1111/chd.12435

Abstract Objective: Enteral feeding is associated with decreased infection rates, decreased mechanical ventilation, decreased hospital length of stay, and improved wound healing. Enteral feeding difficulties are common in congenital heart disease. Our objective was to develop experience-based newborn feeding guidelines for the initiation and advancement of enteral feeding in the cardiothoracic intensive care unit.
Design: This is a retrospective analysis of a quality improvement project.
Setting: This quality improvement project was performed in a cardiothoracic intensive care unit.
Patients: Newborns admitted to the cardiothoracic intensive care unit for cardiac surgery from January 2011 to May 2015 were retrospectively reviewed.
Intervention: Newborn… More >

Shahnawaz M. Amdani, Robert D. Ross, Paul A. Webster, Daniel R. Turner, Thomas J. Forbes, Daisuke Kobayashi

Congenital Heart Disease, Vol.13, No.6, pp. 1028-1037, 2018, DOI:10.1111/chd.12677

Abstract Introduction: Reduction of radiation dosage in the pediatric cardiac catheterization laboratory (PCL) is important to reduce the risk of its stochastic effect in children with congenital heart disease. Lowering the frame rate would reduce radiation dos‐ age possibly at the expense of image quality, potentially resulting in higher fluoro‐ scopic time and procedural complication rate.
Methods: The data were retrospectively analyzed in three eras: era 1 (n = 234), cine‐ angiography 30 frames/sec (f/s) and fluoroscopy 15 pulse/sec (p/s); era 2 (n = 381), cineangiography 30 f/s and fluoroscopy 6 p/s; and era 3 (n = 328), cineangiography 15 f/s… More >

Lindsay A. Edwards^1,2, Christine Bui^2,3, Antonio G. Cabrera^1,2, Jill Ann Jarrell^2,4,5

Congenital Heart Disease, Vol.13, No.3, pp. 362-368, 2018, DOI:10.1111/chd.12579

Abstract Objective: To improve outpatient advanced care planning (ACP) for adults with congenital/pediatric heart disease followed in a pediatric heart failure (HF) and transplant clinic through quality improvement (QI) methodology.
Design: A one-year QI project was completed. We conducted quarterly chart reviews and incorporated feedback from the providers to direct subsequent interventions.
Patients and Setting: Patients ≥18 years of age seen in the HF and Transplant Clinic for followup visit were included in analysis.
Interventions: Interventions focused on five main areas: identifying and training providers to have ACP discussions, standardizing the ACP discussion, standardizing ACP and advance directive (AD) documentation in… More >

Daniel E. Ehrmann¹, Matthew Mulvahill², Shaunda Harendt^1,3, Jessica Church¹, Amy Stimmler¹, Piyagarnt Vichayavilas^1,4, Sanja Batz^1,5, Jennifer Rodgers^1,5, Michael DiMaria¹, James Jaggers¹, Cindy Barrett¹, Jon Kaufman¹

Congenital Heart Disease, Vol.13, No.1, pp. 31-37, 2018, DOI: 10.1111/chd.12550

Abstract Background: Feeding practices after neonatal and congenital heart surgery are complicated and variable, which may be associated with prolonged hospitalization length of stay (LOS). Systematic assessment of feeding skills after cardiac surgery may earlier identify those likely to have protracted feeding difficulties, which may promote standardization of care.
Methods: Neonates and infants ≤3 months old admitted for their first cardiac surgery were retrospectively identified during a 1-year period at a single center. A systematic feeding readiness assessment (FRA) was utilized to score infant feeding skills. FRA scores were assigned immediately prior to surgery and 1, 2, and 3 weeks after… More >

Susan F. Saleeb¹, Sarah R. McLaughlin², Dionne A. Graham², Kevin G. Friedman¹, David R. Fulton¹

Congenital Heart Disease, Vol.13, No.1, pp. 46-51, 2018, DOI:10.1111/chd.12539

Abstract Objective: Using a Standardized Clinical Assessment and Management Plan (SCAMP) for pediatric patients presenting to clinic with chest pain, we evaluated the cost impact associated with implementation of the care algorithm. Prior to introduction of the SCAMP, we analyzed charges for 406 patients with chest pain, seen in 2009, and predicted 21% reduction of overall charges had the SCAMP methodology been used. The SCAMP recommended an echocardiogram for history, examination, or ECG findings suggestive of a cardiac etiology for chest pain.
Design: Resource utilization was reviewed for 1517 patients (7-21 years) enrolled in the SCAMP from July 2010 to April… More >