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Implementation of the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) programme: an interdisciplinary, generalisable approach to inpatient neurodevelopmental care

Published online by Cambridge University Press:  12 April 2023

Kelly R. Wolfe Open the ORCID record for Kelly R. Wolfe [Opens in a new window] ,
Sherrill D. Caprarola Open the ORCID record for Sherrill D. Caprarola [Opens in a new window] ,
Caelah Clark ,
Jesse Davidson ,
Melanie D. Everitt ,
Laura Faul ,
Colton Hageman ,
Sarah L. Kelly Open the ORCID record for Sarah L. Kelly [Opens in a new window] ,
Emily Maloney  and
Hilary Patteson
...Show all authors
Kelly R. Wolfe*
Affiliation:
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
Sherrill D. Caprarola
Affiliation:
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
Caelah Clark
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA
Jesse Davidson
Affiliation:
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
Melanie D. Everitt
Affiliation:
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
Laura Faul
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA
Colton Hageman
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA
Sarah L. Kelly
Affiliation:
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
Emily Maloney
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA
Hilary Patteson
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA
Sarah Scott
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA
Alyse Talbot
Affiliation:
Children’s Hospital Colorado, Aurora, CO, USA
Suhong Tong
Affiliation:
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
Kimberly L. DiMaria
Affiliation:
Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
*
Author for correspondence: Kelly R. Wolfe, PhD, ABPP-CN, 13123 E 16th Ave, B155, Aurora, CO 80016, USA. Tel: +1 720 777 5511; Fax: +1 720 777 7895. E-mail: Kelly.Wolfe@childrenscolorado.org
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Abstract

Background:

Children with CHD are at risk for neurodevelopmental delays, and length of hospitalisation is a predictor of poorer long-term outcomes. Multiple aspects of hospitalisation impact neurodevelopment, including sleep interruptions, limited holding, and reduced developmental stimulation. We aimed to address modifiable factors by creating and implementing an interdisciplinary inpatient neurodevelopmental care programme in our Heart Institute.

Methods:

In this quality improvement study, we developed an empirically supported approach to neurodevelopmental care across the continuum of hospitalisation for patients with CHD using three plan-do-study-act cycles. With input from multi-level stakeholders including parents/caregivers, we co-designed interventions that comprised the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) programme. These included medical/nursing orders for developmental care practices, developmental kits for patients, bedside developmental plans, caregiver education and support, developmental care rounds, and a specialised volunteer programme. We obtained data from the electronic health record for patients aged 0–2 years admitted for at least 7 days to track implementation.

Results:

There were 619 admissions in 18 months. Utilisation of CINCO interventions increased over time, particularly for the medical/nursing orders and caregiver handouts. The volunteer programme launch was delayed but grew rapidly and within six months, provided over 500 hours of developmental interaction with patients.

Conclusions:

We created and implemented a low-cost programme that systematised and expanded upon existing neurodevelopmental care practices in the cardiac inpatient units. Feasibility was demonstrated through increasing implementation rates over time. Key takeaways include the importance of multi-level stakeholder buy-in and embedding processes in existing clinical workflows.

Keywords

Cardiac neurodevelopmentinpatient neurodevelopmental carecardiac intensive carequality improvement
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 12 , December 2023 , pp. 2581 - 2588
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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