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Introduction: The Pediatric Acute Care Cardiology Collaborative (PAC3) was established in 2014 to understand systems and clinical practices in cardiac care delivered outside the intensive care unit with a focus on outcomes, quality improvement, and patient safety. An initial PAC3 project was a comprehensive survey to understand unit structure, practices, and resource utilization across the collaborative. Methods: The survey consisted of 126 stem questions. Many questions had branching logic for positive responses leading to 412 total possible response fields. Questions were categorized into domains: demographics, staffing, resources and therapies, and standard care practices. Five supplemental questions addressed patient and surgical volume variables. Responses were recorded and stored in a REDCap database. Results: Surveys were completed by 31 (91%) of 34 member centers. A majority (19, 61%) of centers have a single, dedicated cardiac acute care unit (ACU), which is contiguous or on the same floor as the ICU in 15 (48%). A nurse staffing ratio of 3:1 is employed in 71% of centers and 26 (84%) reported having a resource nurse. Centralized wireless rhythm monitoring is used in 26 (84%) centers with 14 (54%) staffed continuously. Table 1 shows the use of various high-acuity therapies. Figure 1 illustrates the varied use of protocols and procedures in this population. Conclusions: The PAC3 hospital survey is the most thorough effort to understand systems and clinical care practices in the cardiac ACU to date. It demonstrates notable heterogeneity and varied practice patterns amongst units. Further study may identify a combination of structure and services that can enhance efficiency, safety, and patient outcomes. [ABSTRACT FROM AUTHOR]

Background: The Pediatric Acute Care Cardiology Collaborative (PAC 3 ) was established in 2014 to improve the quality, value, and experience of hospital-based cardiac acute care outside of the intensive care unit. An initial PAC 3 project was a comprehensive survey to understand unit structure, practices, and resource utilization across the collaborative. This report aims to describe the previously unknown degree of practice variation across member institutions., Methods: A 126-stem question survey was developed with a total of 412 possible response fields across nine domains including demographics, staffing, available resources and therapies, and standard care practices. Five supplemental questions addressed surgical case volume and number of cardiac acute care unit (CACU) admissions. Responses were recorded and stored in Research Electronic Data Capture (REDCap)., Results: Surveys were completed by 31 out of 34 centers (91%) with minimal incomplete fields. A majority (61%) of centers have a single dedicated CACU, which is contiguous or adjacent to the intensive care unit in 48%. A nurse staffing ratio of 3:1 is most common (71%) and most (84%) centers employed a resource nurse. Centralized wireless rhythm monitoring is used in 84% of centers with 54% staffed continuously. There was significant variation in the use of noninvasive respiratory support, vasoactive infusions, and ventricular assist devices across the collaborative. Approximately half of the surveyed centers had lesion-specific postoperative pathways and approximately two-thirds had protocols for single-ventricle patients., Conclusions: The PAC 3 hospital survey is the most comprehensive description of systems and care practices unique to CACUs to date. There exists considerable heterogeneity among unit composition and variation in care practices. These variations may allow for identification of best practices and improved quality of care for patients., (© 2019 Wiley Periodicals, Inc.)