Andersons pediatric cardiology 1895
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careprovider.
■Face-to-facedialogisideal,butmore
practicallythisconversationoccursviaphone
■Anticipatoryguidanceandthecreationofa
sharedcaremodelspecificallyasitrelatesto
homemonitoringdata,scheduledvisits,
immunizations,andmanagementduring
commonlyacquiredinfantillness.
■Parentparticipationincarehand-offfrom
inpatienttooutpatientsettingcanshortenand
improveinitialoutpatientencounters,
highlightparentpresenceinthesharedcare
model,andlessenthepotentialstressand
anxietythatoccurswithdischargedhome.
■Writtendocumentssuppliedtooutpatientcare
teams.Paper-basedorelectronicdocumentsserveasa
resourcetooutpatientcareteamsandprovideboth
essentialandsupplementalinformationto
complementtheverbalhand-off.
■Transferofprofessionalresponsibility.Clear
understandingofsharedpatientmanagementamong
theoutpatientcardiologistteam,primarycare
provider,andinterstagemanagementteamis
essential.
OutpatientManagement
HomeMonitoring
Rationaleforhomemonitoringofoxygensaturationsandweighttrendsare
detailedearlier.Callcriteriaorredflagsindicatingpotentialphysiologicconcern
needtobeestablishedbytheinterstageteamandclearlysharedwithparents.
Criteriathatwarrantnotificationoftheinterstagecareteaminclude:
■SpO2lessthan75%orgreaterthan90%
■Weightlossof30gorfailuretogain20gover3
days
■Enteralintakelessthan100mL/kgperday
■Fever,cough,congestion,changeinbreathing
pattern,vomiting,diarrhea,irritability.
Initialtriagebytheinterstagecareteammayresultinanyofthefollowing:
■Weightoroxygensaturationrecheckin-home(same
day)
■Clinicalassessmentbyprimarycareprovideror
referringcardiologist(sameday)
■Interstagecareteamexaminationwithin24hours
■Emergencydepartmentassessment
■Directadmissiontohospital
Parentcommitmenttodailyassessmentandtrendingofweightandoxygen
saturationvalues,theabilitytoidentifychangeifclinicalstatuswarranting
furtherassessment,andtimelycommunicationofconcernstothemedicalteam
isvitaltothesuccessofanyinterstagehomemonitoringprogram.
Nearlyhalfoftheinfantswhoareenrolledinhomemonitoringprogramsare
readmittedtothehospitalduringtheinterstageperiod.4,45Overthecourseof10
years,breachofhomemonitoringoxygensaturationandweightcriteriaalone
occurredatleastoncein86%ofinfantsandwereobservedatsimilarrates
betweenthemodifiedBlalock-Taussig-Thomasshuntandtherightventricleto
pulmonaryarteryconduit(Fig.72.5).Pulseoximetrylessthan75%wasthemost
commonreasonforbreachofcriteria,witharespiratoryillnessaccountingfor
28%ofeventandananatomiccausefor24%.Anemiawasfoundin9%of
events.Thirtypercentofeventsrelatedtooxygensaturationmonitoringcould
notbecategorized.Breachofweightcriteriaaccountedforapproximately40%
ofinterstageeventsandresultedfrominadequateenteralintakeinnearlyhalfof
themonitoredinfants.Anexampleofinterstagemanagementwhenhome
monitoredcriteriawerebreachedisshowninFig.72.6.3
