A Collaborative Learning Assessment of Developmental Care Practices for Infants in the Cardiac Intensive Care Unit

Abstract

Objective: Assess differences in approaches to and provision of developmental care for infants undergoing surgery for congenital heart disease.

Study design: A collaborative learning approach was used to stratify, assess, and compare individualized developmental care practices among multidisciplinary teams at 6 pediatric heart centers. Round robin site visits were completed with structured site visit goals and postvisit reporting. Practices of the hosting site were assessed by the visiting team and reviewed along with center self-assessments across specific domains including pain management, environment, cue-based care, and family based care coordination.

Results: Developmental care for infants in the cardiac intensive care unit (CICU) varies at both a center and individual level. Differences in care are primarily driven by variations in infrastructure and resources, composition of multidisciplinary teams, education of team members, and use of developmental care champions. Management of pain follows a protocol in most cardiac intensive care units, but the environment varies across centers, and the provision of cue-based infant care and family-based care coordination varies widely both within and across centers. The project led to proposed changes in clinical care and center infrastructure at each participating site.

Conclusions: A collaborative learning design fostered rapid dissemination, comparison, and sharing of strategies to approach a complex multidisciplinary care paradigm. Our assessment of experiences revealed marked variability across and within centers. The collaborative findings were a first step toward strategies to quantify and measure developmental care practices in the cardiac intensive care unit to assess the association of complex inpatient practices with long-term neurodevelopmental outcomes.

Keywords: NIDCAP; cardiac intensive care unit; collaborative learning design; congenital heart disease; individualized developmental care.

Conflict of interest statement

The authors declare no conflicts of interest.

Copyright © 2020 Elsevier Inc. All rights reserved.

Figures

Figure 1:. Schematic of the Collaborative Learning approach.

The diagram (adapted from previous experience with Collaborative Learning in the Pediatric Heart Network) outlines the stepwise approach proposed to systematically assess the impact of developmental care on clinical outcomes in Congenital Heart Disease. In the absence of an established standard, the process begins with evaluating and distilling current approaches and differences between sites. This manuscript describes the findings of the steps in bold.

Figure 2:. Care Self-Assessment:

Distribution of self-assessment scores in selected domains of thePhysical Environment of the Hospital and Nursery andPhilosophy and Implementation of Care: Infant subdomains from the NIDCAP Nursery Assessment Manual. Each scale is rated on a 5 point continuum from 1= traditional care to 5=highly attuned individualized developmental care. NIDCAP training and consultation intends to aid the ICU in achieving ultimately consistent developmental care implementation with scores of 3.5 or better.