Feasibility of Implementation of a Heart Failure Communication Checklist in the Multi-Center Action Network

Abstract

<h3>Purpose</h3> Children admitted for acute decompensated heart failure (HF) have significant morbidity and mortality. Improving communication about pediatric-specific HF symptoms and treatment goals among team members and families may help improve outcomes including length of stay (LOS) and hospital readmission rate. <h3>Methods</h3> A 13-item pediatric-specific HF communication checklist tool (HFcc) was developed by expert consensus covering key daily HF assessments and goals including weight trend, cardiac rhythm, pediatric-specific HF symptoms, fluid management, feeding tolerance, anticoagulation, HF medications and doses, HF severity score, and barriers to discharge. The HFcc was implemented across the multi-center Advanced Cardiac Therapies Improving Outcomes Network (ACTION). Each participating ACTION institution recorded daily use of the HFcc by scanning a QR code and reported HF admission outcomes including LOS, readmission rate, death, heart transplant (HT), and placement of a ventricular assist (VAD). <h3>Results</h3> Between 1/26/2021-10/5/2021, 16 ACTION institutions recorded use of the HFcc in 112 individual patients (a total of 1483 uses) with increased usage over time (Figure 1). Enrollment data were available for 73 patients (53% cardiomyopathy, 36% congenital heart disease, 5% HT, 6% other); 38 patients were discharged (3 with VAD), 19 were listed for HT (12 underwent HT during admission), and 4 deaths were reported at the time of data analysis. HFcc use was recorded in 23% of total hospital days (935/4121 days). The median LOS was 16.5 days. For 31 patients with 30-day follow-up data, 8 were readmitted (86% unplanned). <h3>Conclusion</h3> Adoption of a pediatric-specific HF communication checklist tool across pediatric multiple centers is feasible. Further work to improve daily HFcc usage and assess the impact of the HFcc tool on pediatric HF outcomes is planned.