Transposition of the Great Arteries (TGA), Newborn — Goals and Metrics — Clinical Pathway: ICU and Inpatient

Transposition of the Great Arteries (TGA) Clinical Pathway — CICU

Goals

Prenatal

  • To increase the number of community referrals for prenatal suspicion of TGA
    • Outreach and education to increase identification of abnormal vessel relationship at 20-week obstetrical ultrasound

Pre-operative

  • Optimize systemic arterial oxygen content
  • Optimize nutrition
  • Operative correction by DOL 4 if without complications

Post-operative

  • Time to Extubation: POD 2 (1-4 days)
  • Post-op CICU LOS: POD 6 (5-8 days)
  • Post-op Total LOS: POD 11 (8-28 days)
Median post-operative day (and interquartile range) for time to extubation, time to transfer out of the CICU, and time to discharge home for patients with TGA and no VSD undergoing arterial switch operation at Children's Hospital of Philadelphia from March 2019 through February 2020.

Discharge

  • Early recognition of hemodynamic problems and arrhythmia
  • Minimize medication need
  • Ensure adequate nutrition and growth
  • Ensure proper referral to support services

Metrics

Prenatal

  • Percent recognition of TGA before birth within the Delaware region
  • Goal > 75%

Pre-operative

  • Percent of infants with TGA without contraindication who have repair by DOL 4 (goal 95%)
  • Percent of infants without contraindication to enteral feeds started on enteral feeds before OR repair (goal 95%)

Post-operative

  • Time to extubation
  • Post-op CICU LOS
  • Post-op total LOS
  • Days to feed initiation
  • Complications

Discharge

  • Adequate growth
  • Percentage of patients requiring
    • Urgent interventions
    • Elective interventions