Shashikanth Reddy Ambati, MD
Assistant Professor
Albany Medical Center
Albany, NY
Disclosure information not submitted.
Neil Devejian, MD
Associate professor
Albany Medical Center, United States
Disclosure information not submitted.
Adnan Bakar, BA, MD
Associate Professor
Albany Medical Center, United States
Disclosure information not submitted.
Nicole Betancourt, MD
Assistant Professor
Albany Medical Center, United States
Disclosure information not submitted.
Suzanne Barry, DO
Assistant Professor
Albany Medical Center - The Vascular Group, United States
Disclosure information not submitted.
Kathleen Ventre, MD
Associate Professor
Albany Medical Center, United States
Disclosure information not submitted.
Javier Sanchez, MD
Clinical Professor
Albany Medical Center, United States
Disclosure information not submitted.
Title: Establishing Cardiac Nursing Competency in a Low-Volume Congenital Heart Surgery Center
Introduction: Hannan, in a retrospective cohort study using 1992-1995 New York State database concluded that significantly higher mortality is associated with pediatric cardiac surgery volumes of less than 100 and surgeons with less than 75 cases per year. Subsequent studies have questioned that volume alone is responsible for lower mortality rates at high volume centers. Surgical outcomes result from the competency of the entire team, including the surgeon, cardiologists, intensivists, and nursing staff. We believe establishing cardiac nursing competency is critical to achieving good outcomes, especially in low-volume centers. There is little literature on how to maintain nursing competencies. We describe how improving nursing competency improved outcomes in a low-volume cardiac center.
Methods: We introduced a specialized Cardiac Nurse Training Program in 2013. The cardiac nurse pool is limited to maximize experience. Monitoring was put in place to ensure a constant pool of cardiac nurses with appropriate training, flexible enough to take care of postoperative cardiac patients at any time. After a 20-week orientation program mandating completion of a dedicated skills checklist, nurses are rated on a 5-point scale of expertise. Assignments are based on cardiac lesions and nursing expertise. To maintain their clinical skills, a varied case mix is monitored by a Nurse Clinician. Skill sets are maintained by weekly lectures by cardiac surgeon and cardiologists along with monthly simulation cases led by intensivists. Annual attendance of a national cardiac conference is also required.
Results: We have trained 32 nurses over 8 years with 56% (18/32) retention. Our center reports outcome data to both Society of Thoracic Surgeons Database and New York State Pediatric Cardiac Surgery Reporting System. Implementation of dedicated cardiac nurse training program showed, an improvement of risk-adjusted mortality rate for our center from 3.84 CI 95% (1.98-6.71) based on 2010-2013 data to 2.17 CI 95% (0.70-5.08) based on 2014-2017 data for Pediatric Congenital Cardiac Surgery in New York State.
Conclusion: Although there may be other factors that contributed to the improved mortality rate during this time, we believe establishing cardiac nurse competency played a key role in improving outcomes in our low-volume center.