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1.
Curr Opin Cardiol ; 39(4): 356-363, 2024 Jul 01.
Article in English | MEDLINE | ID: mdl-38547042

ABSTRACT

PURPOSE OF REVIEW: The purpose of this review is to examine high reliability through the lens of a contemporary pediatric heart center, noting that continuous improvement, rather than perfection, should be embraced. Aiming to elevate topics with lesser attention, this review elaborates on key concepts and proposed considerations for maintaining a high reliability heart center. RECENT FINDINGS: As provision of care reaches a new complexity, programs are called upon to evaluate how they can bring their teams into the future of pediatric cardiac care. Although much has been written about high reliability in healthcare, it has not been explored within pediatric heart centers. Practical application of high reliability enables a shared mental model and aligns teams toward eliminating patient harm. Suggested facilitators of high reliability within heart center teams include interprofessional collaboration, recognition of nursing expertise, psychological safety, and structural empowerment void of hierarchy. SUMMARY: As the pediatric cardiac population evolves, care becomes more complex with a narrow margin of error. High reliability can guide continuous improvement. Acknowledging culture as the underpinning of all structure and processes allows teams to rebound from failure and supports the mission of rising to exceptional patient challenges.


Subject(s)
Patient Care Team , Humans , Child , Cardiac Care Facilities/organization & administration , Quality Improvement , Reproducibility of Results
2.
Cardiol Young ; : 1-10, 2022 Dec 23.
Article in English | MEDLINE | ID: mdl-36562257

ABSTRACT

Early surgical intervention in infants with complex CHD results in significant disruptions to their respiratory, gastrointestinal, and nervous systems, which are all instrumental to the development of safe and efficient oral feeding skills. Standardised assessments or treatment protocols are not currently available for this unique population, requiring the clinician to rely on knowledge based on neonatal literature. Clinicians need to be skilled at evaluating and analysing these systems to develop an appropriate treatment plan to improve oral feeding skill and safety, while considering post-operative recovery in the infant with complex CHD. Supporting the family to re-establish their parental role during the hospitalisation and upon discharge is critical to reducing parental stress and oral feeding success.

3.
Cardiol Young ; 31(4): 589-596, 2021 Apr.
Article in English | MEDLINE | ID: mdl-33303052

ABSTRACT

Congenital heart disease (CHD) is the most common birth defect for infants born in the United States, with approximately 36,000 affected infants born annually. While mortality rates for children with CHD have significantly declined, there is a growing population of individuals with CHD living into adulthood prompting the need to optimise long-term development and quality of life. For infants with CHD, pre- and post-surgery, there is an increased risk of developmental challenges and feeding difficulties. Feeding challenges carry profound implications for the quality of life for individuals with CHD and their families as they impact short- and long-term neurodevelopment related to growth and nutrition, sensory regulation, and social-emotional bonding with parents and other caregivers. Oral feeding challenges in children with CHD are often the result of medical complications, delayed transition to oral feeding, reduced stamina, oral feeding refusal, developmental delay, and consequences of the overwhelming intensive care unit (ICU) environment. This article aims to characterise the disruptions in feeding development for infants with CHD and describe neurodevelopmental factors that may contribute to short- and long-term oral feeding difficulties.


Subject(s)
Heart Defects, Congenital , Quality of Life , Adult , Caregivers , Child , Emotions , Heart Defects, Congenital/epidemiology , Humans , Infant , Parents
4.
Curr Opin Pediatr ; 24(3): 295-300, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22572758

ABSTRACT

PURPOSE OF REVIEW: Adequate enteral nutrition and growth are vital to recovery and survival of infants following palliation for univentricular hearts. This group of patients experiences frequent feeding complications that may impede adequate delivery of enteral nutrition. This review presents the most recent data related to feeding practices, growth patterns and outcomes. It also explores management strategies for delivering enteral nutrition safely and effectively to this high-risk group of infants. RECENT FINDINGS: Infants following palliation for single ventricle physiology have persistent growth failure until at least 14 months of life. Greater daily caloric intake attenuates this growth failure. Persistent growth failure is associated with increased mortality following cardiac surgery. Management of enteral nutrition varies widely both pre and postoperatively. Data suggest that standardizing feeding practices improves delivery of enteral nutrition and decreases feeding complications. Evidence-based international feeding guidelines do not exist. SUMMARY: Delivery of adequate nutrition in infants with single ventricle physiology is essential to improve outcomes but is often difficult to achieve. Evidence-based feeding guideline development is crucial to improve outcomes in this group of patients.


Subject(s)
Heart Ventricles/abnormalities , Infant Nutritional Physiological Phenomena , Algorithms , Enteral Nutrition/methods , Heart Ventricles/surgery , Humans , Hypoplastic Left Heart Syndrome/surgery , Hypoplastic Left Heart Syndrome/therapy , Infant , Perioperative Care/methods
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