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首页> 外文期刊>Congenital heart disease. >Initiating a Fontan multidisciplinary clinic: Decreasing care variability, improving surveillance, and subsequent treatment of Fontan survivors
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Initiating a Fontan multidisciplinary clinic: Decreasing care variability, improving surveillance, and subsequent treatment of Fontan survivors

机译：启动Fontan多学科诊所：减少护理变异，改善监测，随后治疗Fontan幸存者

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Abstract Background Children with single ventricle (SV) heart disease who undergo Fontan operation are at risk for developing?multiorgan dysfunction. Although survival has improved, significant comorbidities involving multiple organ systems may develop, requiring evaluation and management by many subspecialists. Using data from an internal survey, we documented high care variability for our Fontan population. We then developed a multidisciplinary clinic, designed and implemented a clinical care pathway to decrease variability of patient assessment. Methods After creating a multidisciplinary team and a clinical care pathway, we initiated a multidisciplinary clinic (MDC) where patients could see multiple subspecialists during a single encounter. We then monitored our effectiveness by retrospective chart review to determine care pathway adherence (process measure) and incidence of new diagnoses of end‐organ injury (outcome measure) as well interventions implemented. Adherence was analyzed using statistical process control (SPC) charts. Results Eighty‐six patients were seen in the MDC from January 2016 to September 2017. The proportion of patients with appropriate testing increased, related to strong care pathway adherence. A significant amount of novel pathology was diagnosed in all evaluated organ systems, both Fontan‐associated comorbidities and general pediatric diagnoses. Subsequent interventions included cardiac catheterization n = 21 (31%) with more than half of these patients undergoing intervention n = 17 (20%), and liver biopsy n = 9 (10%). Additionally, 58 patients (67%) were referred to a neuropsychologist based on perceived clinical need, with n = 34 (40%) undergoing a neuropsychological evaluation. Conclusions Children who have undergone Fontan palliation are at risk for developing cardiac and noncardiac comorbidities. Use and adherence to an institutional care pathway resulted in the diagnosis of significant novel pathology and subsequently provided opportunity for intervention.
机译：随着Fontan操作的唯一心室（SV）心脏病的抽象背景儿童有风险开发？多功能障碍。虽然生存期有所改善，但涉及多个器官系统的显着合并症可能会产生许多亚专科学家的评估和管理。从内部调查中使用数据，我们为我们的Fontan人口记录了高级护理变化。然后，我们开发了多学科诊所，设计和实施了临床护理途径，以降低患者评估的可变性。方法在创建多学科团队和临床护理途径后，我们发起了多学科诊所（MDC），其中患者在单一遭遇期间可以看到多个亚专科学家。然后，我们通过回顾性的图表审查监测了我们的有效性，以确定所实施的干预措施的护理途径遵守（过程测量）和新诊断的新诊断（结果措施）。使用统计过程控制（SPC）图表分析依从性。结果2016年1月至2017年1月，MDC中看到了八十六名患者。适当测试患者的比例增加，与强烈的护理途径依从性有关。在所有评估的器官系统中诊断出大量新的病理学，包括Fontan相关的合并症和通用儿科诊断。随后的干预包括心脏导管插入率n = 21（31％），这些患者中有超过一半的患者进行干预N = 17（20％），肝活组织检查N = 9（10％）。此外，根据感知临床需要，58名患者（67％）被称为神经心理学家，N = 34（40％）进行神经心理学评估。结论经过Fontan Palliation的儿童有风险促进心脏和非心律病患者。使用和遵守制度护理途径导致诊断显着的新型病理学，随后提供干预的机会。

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