An Active Surveillance and Referral Program to Ensure Respiratory Syncytial Virus Prophylaxis for the Pediatric Congenital Heart Disease Population: A Quality Improvement Project

Abstract

Background: Congenital heart disease (CHD) is the leading cause of death within the first year of life because of birth defects. Complications related to respiratory infection caused by respiratory syncytial virus (RSV) increase risks in the CHD population. Prevention is key to minimizing risk, and administration of RSV prophylaxis, palivizumab, is recommended for infants with hemodynamically significant heart disease. Objective: Use the electronic medical record (EMR) to identify and ensure appropriate referral of CHD patients eligible for RSV prophylaxis. Design: Comparative, cross-sectional study design. Setting: Cardiac specialty clinic of a regional children’s hospital. Population: CHD patients younger than 24 months of age eligible for RSV prophylaxis. Intervention: Use the EMR to develop a method for identifying CHD patients eligible for RSV prophylaxis and implement a referral process. Results: Similar number of patients in the 2 RSV seasons studied. Rates of eligibility for RSV prophylaxis over the 2 seasons were the same. Improvements in documentation of eligibility by the provider from the first season to the second. Limitations: Inability to determine referral rates. Initial EMR search did not identify patients eligible for RSV prophylaxis. Inconsistent EMR data entry. Conclusions: Ongoing education on eligibility for RSV prophylaxis. Need for automated EMR referral. Ongoing evaluation of EMR systems identifying patients eligible for RSV prophylaxis.