Critical pathways for postoperative care after simple congenital heart surgery

Objective: To evaluate the clinical, financial, and parent/patient satisfac tion impact of critical pathways on the postoperative cave of pediatric car diothoracic patients with simple congenital heart lesions. Study Design: Critical pathways were developed by pediatric intensive care nurses and implemented under the direction of pediatric cardiothoracic surg eons. Patients and Methods: Critical pathways were used during a 12-month study o n 46 postoperative patients with simple repair of atrial septal defect (ASD ), coarctation of the aorta (CoA), and patent ductus arteriosus (PDA). Usin g the study criteria, a control group of 58 patients was chosen from 1993. Prospective and control group data collected included postoperative intubat ion time, total laboratory tests, arterial blood gas utilization, morphine utilization, time in the pediatric intensive care unit, total hospital stay , total hospital charges, total hospital cost, and complications. Variances from the critical pathway and satisfaction data were also recorded for stu dy patients. Results: Resource utilization was reduced after implementation of critical pathways. Significant reductions were seen in total hours in the pediatric intensive care unit, total number of laboratory tests, postoperative intuba tion times, arterial blood gas utilization, morphine utilization, length of hospitalization (ASD, 4.9 to 3.1 days; CoA, 5.2 to 3.2 days; and PDA, 4.1 to 1.4 days; all P < 0.05), total hospital charges (ASD, $16,633 to $13,627 ; CoA, $14,292 to $8319; and PDA, $8249 to $4216; all P< 0.05), and total h ospital costs. There was no increase in respiratory complications or other complications. Patients and families were generally satisfied with their ho spital experience, including analgesia and length of hospitalization. Conclusion: Implementation of critical pathways reduced resource utilizatio n and costs after repair of three simple congenital heart lesions, without obvious complications or patient dissatisfaction.