Clinical Pathway for the Fontan Patient to Standardize Care
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The Fontan repair is the final stage of surgical palliation for the pediatric patient with a single ventricle heart. The post-operative medical management of this patient population can be variable and hospital length of stay prolonged. With the evidence-based practice movement, healthcare institutions have embraced clinical pathways as a means to standardize care and improve quality. The purpose of the retrospective quasi-experimental cohort project was to determine if the implementation of an evidenced-based clinical pathway for post-operative management of the Fontan patient at a large academic pediatric medical center in the Midwest would standardize care and decrease length of stay. Components of the clinical pathway include 1) supplemental oxygen until pleural drainage tubes are removed, 2) fluid restriction to 80% daily maintenance and a prescribed low-fat diet, 3) aggressive and standardized diuretic therapy while inpatient, and 4) central venous access. Charts were reviewed from consecutive immediate post-operative Fontan patients from 2014-2015, pre-pathway implementation, and 2017-2018, post-pathway implementation, with total sample size of 67 patients (37 pre-, 30 post-). Key outcomes measured were adherence to the pathway, length of stay, and readmissions for pleural effusion. Adherence to the pathway was nearly 100% with a statistically significant decrease in LOS from 12 to 9 days (p = .007) and no increase in readmissions (p = 0.500). Standardizing care can improve clinical outcomes for the Fontan patient population without negatively impacting quality of care, thus providing a positive benefit to the healthcare institution, industry, and patient.
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