A New Progressive Pediatric Cardiac Care Unit

Innovative hospital unit is designed to strengthen care and reduce length of stay and readmissions for patients discharged from the pediatric cardiac intensive care unit.

PCUnurses

In the PCU, from left, nurse practitioners Pat Kane, Nichole Fusco and Annie Grace with nurse manager Sapana Edwards and pediatric cardiologist Lasya Gaur.

When their pediatric cardiac intensive care unit (PCICU) opened its doors in 2020, Johns Hopkins pediatric cardiologists felt it offered advantages over traditional intensive care unit (ICU) cardiac care, including shorter ventilator stays. Experience has proved that to be true. Now, in a move to shorten overall hospital stays, Johns Hopkins Children’s Center has opened a new pediatric cardiac unit (PCU) that offers provider skill sets and services beyond those found in a traditional acute inpatient unit.

“We are enhancing the strength of the team by recruiting pediatric cardiac nurses and nurse practitioners who are working alongside pediatric cardiology attendings and our pediatric cardiology fellows in caring for our patients,” says Shelby Kutty, director of the Division of Pediatric and Congenital Cardiology. “Enhanced services will allow us to care for sicker patients who can transition faster from pediatric cardiac intensive care to the floor and potentially go home sooner, thereby making our length of stays even shorter.”

“A team of pediatric cardiologists, nurse practitioners, pediatric cardiac intensivists, nurses and nurse educators has worked together for months utilizing best practices and evidence-based methods in creating this unit, which is set to assume a higher level of care than prior,” adds Lasya Gaur, pediatric cardiologist and interim inpatient director of the PCU. “The overarching goal is to allow our patients to ‘graduate’ from the intensive care unit faster and focus on specific goals for safe discharge home.”

Multidisciplinary services on the PCU will include pulmonology, child life, nutrition, feeding specialists, physical and occupational therapy, respiratory therapy and social work. Also, while ambulating on the unit, patients will be monitored with state-of-the-art telemetry to speed recovery and safely simulate home activities.

“There will be significant monitoring, as well as guided therapeutic interventions specific to children with acquired and congenital heart disease,” says pediatric cardiac critical care specialist Darren Klugman, director of pediatric cardiac critical care. “It will provide patients a more comfortable inpatient environment and allow us to provide additional therapies with a focus on neurodevelopmental outcomes.”

One goal of the unit is to reduce ICU readmissions, with studies showing postoperative complications and in-hospital mortality rates significantly higher among patients readmitted to an ICU. Klugman points to growing evidence that a progressive cardiac care model in the continuum of care improves outcomes and reduces length of stay.

“If we do this properly,” he says, “we will move pediatric patients quicker through intensive care and improve ICU capacity, which is an ongoing challenge in the hospital as our program gets busier and busier.”

Key to the progressive cardiac care model is advanced nursing. Children’s Center nurses, says the PCU’s nurse manager, Sapana Edwards, have had cardiac and critical care training to work in the unit, which opened Aug. 31 on the ninth floor of the Children’s Center.

“Nurses on this floor saw this as a challenge, but one they were very excited about,” says Edwards. “They are now confident and skilled with this population of patients.”

“Families should feel assured that they have a highly trained team caring for their child, including board-certified pediatric cardiologists and cardiology fellows, nurse practitioners and nursing staff,” says Gaur.

Regarding the recently opened Blalock-Taussig-Thomas Pediatric and Congenital Heart Center and the PCICU, along with the PCU, Kutty concludes, “Our goal is to launch an unmatched level of expertise of heart care in the region.”