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Going home after infant cardiac surgery: a UK qualitative study
  1. Jenifer Tregay1,
  2. Jo Wray1,
  3. Sonya Crowe2,
  4. Rachel Knowles3,
  5. Piers Daubeney4,5,
  6. Rodney Franklin4,
  7. David Barron6,
  8. Sally Hull7,
  9. Nick Barnes8,
  10. Catherine Bull1,
  11. Katherine L Brown1
  1. 1Cardiac Unit, Great Ormond Street Hospital NHS Foundation Trust, London UK
  2. 2Clinical Operational Research Unit, University College London, London, UK
  3. 3Population, Policy and Practice Programme, UCL Institute of Child Health, London UK
  4. 4Paediatric Cardiac Unit, Royal Brompton and Harefield Hospitals NHS Trust, London, UK
  5. 5Royal National Heart and Lung Institute, Imperial College, London UK
  6. 6Cardiac Surgery Department, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
  7. 7Primary Care Department, Queen Mary's University, London UK
  8. 8Department of Paediatrics, Northampton General Hospital NHS Trust, Northampton UK
  1. Correspondence to Dr Katherine Brown, Cardiac Unit, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, UK; Katherine.Brown{at}gosh.nhs.uk

Abstract

Objective To qualitatively assess the discharge processes and postdischarge care in the community for infants discharged after congenital heart interventions in the first year of life.

Design Qualitative study using semistructured interviews and Framework Analysis.

Setting UK specialist cardiac centres and the services their patients are discharged to.

Subjects Twenty-five cardiologists and nurses from tertiary centres, 11 primary and secondary health professionals and 20 parents of children who had either died after discharge or had needed emergency readmission.

Results Participants indicated that going home with an infant after cardiac intervention represents a major challenge for parents and professionals. Although there were reported examples of good care, difficulties are exacerbated by inconsistent pathways and potential loss of information between the multiple teams involved. Written documentation from tertiary centres frequently lacks crucial contact information and contains too many specialist terms. Non-tertiary professionals and parents may not hold the information required to respond appropriately when an infant deteriorates, this contributing to the stressful experience of managing these infants at home. Where they exist, the content of formal ‘home monitoring pathways’ varies nationally, and families can find this onerous.

Conclusions Service improvements are needed for infants going home after cardiac intervention in the UK, focusing especially on enhancing mechanisms for effective transfer of information outside the tertiary centre and processes to assist with monitoring and triage of vulnerable infants in the community by primary and secondary care professionals. At present there is no routine audit for this stage of the patient journey.

  • Paediatric
  • Cardiac
  • Surveillance
  • Community
  • Cardiology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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