Search

Your search keyword '"Madsen, Nicolas L."' showing total 137 results
Start Over Author "Madsen, Nicolas L."
137 results on '"Madsen, Nicolas L."'

1. Center Variation in Chest Tube Duration and Length of Stay After Congenital Heart Surgery

Author

Bates, Katherine E, Madsen, Nicolas L, Khadr, Lara, Gao, Zhiqian, Crawford, Kari, Gaies, Michael, Graupe, Margaret, Hanke, Samuel P, Hlavacek, Anthony M, Morell, Evonne, Pasquali, Sara K, Russell, Jennifer L, Schachtner, Susan K, Tanel, Ronn E, Ware, Adam L, and Kipps, Alaina K

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Patient Safety, Pediatric, Heart Disease, Cardiovascular, Chest Tubes, Device Removal, Female, Heart Defects, Congenital, Humans, Infant, Infant, Newborn, Length of Stay, Male, Postoperative Care, Practice Patterns, Physicians', Time Factors, Cardiorespiratory Medicine and Haematology, Respiratory System, Cardiovascular medicine and haematology, Clinical sciences
Abstract

BackgroundNearly every child undergoing congenital heart surgery has chest tubes placed intraoperatively. Center variation in removal practices and impact on outcomes has not been well described. This study evaluated variation in chest tube management practices and outcomes across centers.MethodsThe study included patients undergoing any of 10 benchmark operations from June 2017 to May 2018 at participating Pediatric Acute Care Cardiology Collaborative (PAC3) and Pediatric Cardiac Critical Care Consortium (PC4) centers. Clinical data from PC4 centers were merged with chest tube data from PAC3 centers. Practices and outcomes were compared across centers in univariate and multivariable analysis.ResultsThe cohort included 1029 patients (N = 9 centers). Median chest tube duration varied significantly across centers for 9 of 10 benchmark operations (all P ≤ .03), with a "model" center noted to have the shortest duration for 9 of 10 operations (range, 27.9% to 87.4% shorter duration vs other centers across operations). This effect persisted in multivariable analysis (P < .0001). The model center had higher volumes of chest tube output before removal (median, 8.5 mL/kg/24 h [model] vs 2.2 mL/kg/24 h [other centers]; P < .001], but it did not have higher rates of chest tube reinsertion (model center 1.3% vs 2.1%; P = .59) or readmission for pleural effusion (model center 4.4% vs 3.0%; P = .31), and had the shortest length of stay for 7 of 10 operations.ConclusionsThis study suggests significant center variation in chest tube removal practices and associated outcomes after congenital heart surgery. Best practices used at the model center have informed the design of an ongoing collaborative learning project aimed at reducing chest tube duration and length of stay.

Published
2020

8. Abstract 14034: Sustaining and Spreading Success: Longer Term Outcomes and Spread of a Multi-Center Quality Improvement Project to Reduce Post-operative Chest Tube (CT) Duration (on Behalf of the Pediatric Acute Care Cardiology Collaborative and Pediatric Cardiac Critical Care Consortium)

Author

Sheth, Shreya S, Kipps, Alaina, Madsen, Nicolas L, Khadr, Lara, Graupe, Margaret, Tignor, Ashlin, FIGUEROA, MAYTE, Greiten, Lawrence, Hart, Stephen, Jensen, Megan, Mauney, Jennifer A, Morse, Taylor, Patel, Madalsa, St John, Amelia, Saudek, David, and Bates, Katherine E

Published
2020
Full Text
View/download PDF

13. Management of routine postoperative pain for children undergoing cardiac surgery: a Paediatric Acute Care Cardiology Collaborative Clinical Practice Guideline

Author

Gal, Dana B., primary, Clyde, Caitlin O., additional, Colvin, Erin L., additional, Colyer, Jessica, additional, Ferris, Anne M., additional, Figueroa, Mayte I., additional, Hills, Brittney K., additional, Lagergren, Sarah M., additional, Mangum, Jordan, additional, Mann, Jessica L., additional, McKeta, Angela S., additional, Patel, Sonali S., additional, Reeves, Jennifer F., additional, Richter, Molly, additional, Ring, Lisa M., additional, Rosenblum, Joshua M., additional, Tindel, Kaitlin, additional, Weiner, Jeffrey G., additional, Williams, Kimberly G., additional, Zabala, Luis M., additional, and Madsen, Nicolas L., additional

Published
2022
Full Text
View/download PDF

14. Accelerating improvement: The Pediatric Acute Care Cardiology Collaborative data timeliness project

Author

Graupe, Margaret, primary, Tignor, Ashlin, additional, Veneziale, Kelly, additional, Jensen, Megan, additional, Khadr, Lara, additional, Beckstrom, Heather, additional, Gister, Martin, additional, Hendricks, Karen, additional, Madsen, Nicolas L, additional, Roberts, Frederick, additional, Youngberg, Sarah, additional, and Schachtner, Susan, additional

Published
2022
Full Text
View/download PDF

21. Successful Reduction of Postoperative Chest Tube Duration and Length of Stay After Congenital Heart Surgery: A Multicenter Collaborative Improvement Project

Author

Bates, Katherine E., primary, Connelly, Chloe, additional, Khadr, Lara, additional, Graupe, Margaret, additional, Hlavacek, Anthony M., additional, Morell, Evonne, additional, Pasquali, Sara K., additional, Russell, Jennifer L., additional, Schachtner, Susan K., additional, Strohacker, Courtney, additional, Tanel, Ronn E., additional, Ware, Adam L., additional, Wooton, Sharyl, additional, Madsen, Nicolas L., additional, and Kipps, Alaina K., additional

Published
2021
Full Text
View/download PDF

27. Improving Discharge Efficiency and Charge Containment on a Pediatric Acute Care Cardiology Unit.

Author

Madsen, Nicolas L., Porter, Andrew, and Cable, Rhonda

Subjects
*MEDICAL economics, *LENGTH of stay in hospitals, *COST control, *PEDIATRICS, *PATIENT readmissions, *HOSPITAL admission & discharge, *CARDIOVASCULAR system, *QUALITY assurance, *CRITICAL care medicine, *HEALTH care teams, *DESCRIPTIVE statistics, *HOSPITAL charges, *DISCHARGE planning
Abstract

BACKGROUND: Hospital discharge delays can negatively affect patient flow and hospital charges. Our primary aim was to increase the percentage of acute care cardiology patients discharged within 2 hours of meeting standardized medically ready (MedR) discharge criteria. Secondary aims were to reduce length of stay (LOS) and lower hospital charges. METHODS: A multidisciplinary team used quality improvement methods to implement and study MedR discharge criteria in our hospital electronic health record. The criteria were ordered on admission and modified on daily rounds. Bedside nurses documented the time when all MedR discharge criteria were met. A statistical process control chart measured interventions over time. Discharge before noon and 30-day readmissions were also tracked. Average LOS was examined, comparing the first 6 months of the intervention period to the last 6 months. Inpatient charges were reviewed for patients with >2 hours MedR discharge delay. RESULTS: The mean percentage of patients discharged within 2 hours of meeting MedR discharge criteria increased from 20% to 78% over 22 months, with more patients discharged before noon (19%-32%). Median LOS decreased from 11 days (interquartile range: 6-21) to 10 days (interquartile range: 5-19) (P 5 .047), whereas 30-day readmission remained stable at 16.3%. A total of 265 delayed MedR discharges beyond 2 hours occurred. The sum of inpatient charges from care provided after meeting MedR criteria was $332 038 (average $1253 per delayed discharge). CONCLUSIONS: Discharge timeliness in pediatric acute care cardiology patients can be improved by standardizing medical discharge criteria, which may shorten LOS and decrease medical charges. [ABSTRACT FROM AUTHOR]

Published
2021
Full Text
View/download PDF

28. High Acuity Therapy Variation Across Pediatric Acute Care Cardiology Units: Results from the Pediatric Acute Care Cardiology Collaborative Hospital Surveys.

Author

Harahsheh, Ashraf S., Kipps, Alaina K., Hart, Stephen A., Cassidy, Steven C., Clabby, Martha L., Hlavacek, Anthony M., Hoerst, Amanda K., Graupe, Margaret A., Madsen, Nicolas L., Bakar, Adnan M., Del Grippo, Erica L., Patel, Sonali S., Bost, James E., and Tanel, Ronn E.

Subjects
PEDIATRIC therapy, HOSPITAL surveys, CONTINUOUS positive airway pressure, CARDIOLOGY, SURGICAL clinics
Abstract

We utilized the multicenter Pediatric Acute Care Cardiology Collaborative (PAC3) 2017 and 2019 surveys to describe practice variation in therapy availability and changes over a 2-year period. A high acuity therapies (ATs) score was derived (1 point per positive response) from 44 survey questions and scores were compared to center surgical volume. Of 31 centers that completed the 2017 survey, 26 also completed the 2019 survey. Scores ranged from 11 to 34 in 2017 and 11 to 35 in 2019. AT scores in 2019 were not statistically different from 2017 scores (29/44, IQR 27–32.5 vs. 29.5/44, IQR 27–31, p = 0.9). In 2019, more centers reported initiation of continuous positive airway pressure (CPAP) and Bi-level positive airway pressure (BiPAP) in Acute Care Cardiology Unit (ACCU) (19/26 vs. 4/26, p < 0.001) and permitting continuous CPAP/BiPAP (22/26 vs. 14/26, p = 0.034) compared to 2017. Scores in both survey years were significantly higher in the highest surgical volume group compared to the lowest, 33 ± 1.5 versus 25 ± 8.5, p = 0.046 and 32 ± 1.7 versus 23 ± 5.5, p = 0.009, respectively. Variation in therapy within the ACCUs participating in PAC3 presents an opportunity for shared learning across the collaborative. Experience with PAC3 was associated with increasing available respiratory therapies from 2017 to 2019. Whether AT scores impact the quality and outcomes of pediatric acute cardiac care will be the subject of further investigation using a comprehensive registry launched in early 2019. [ABSTRACT FROM AUTHOR]

Published
2021
Full Text
View/download PDF

36. Databases for Congenital Heart Defect Public Health Studies Across the Lifespan

Author

Riehle‐Colarusso, Tiffany J., primary, Bergersen, Lisa, additional, Broberg, Craig S., additional, Cassell, Cynthia H., additional, Gray, Darryl T., additional, Grosse, Scott D., additional, Jacobs, Jeffrey P., additional, Jacobs, Marshall L., additional, Kirby, Russell S., additional, Kochilas, Lazaros, additional, Krishnaswamy, Asha, additional, Marelli, Arianne, additional, Pasquali, Sara K., additional, Wood, Thalia, additional, Oster, Matthew E., additional, Abarbanell, Ginnie Lee, additional, Adams, Faith, additional, Allen, Steven W., additional, Allen, Sydney, additional, Ambrose, Anand, additional, Backer, Carl Lewis, additional, Baer, Andrea, additional, Baker‐Smith, Carissa Marie, additional, Barmash, Mona, additional, Basken, Amy, additional, Bates, Cassandra, additional, Batlivala, Sarosh Percy, additional, Beekman, Robert H., additional, Belmont, John William, additional, Benke, Joshua, additional, Berger, Stuart, additional, Bockerstette, JR, additional, Boris, Jeffrey R., additional, Botto, Lorenzo, additional, Boucher, Jackie, additional, Hageman, Dana Brock, additional, Soto, Cheryl Brosig, additional, Burns, Kristin Marie, additional, Cameron, Lenore, additional, Campbell, Robert M., additional, Colan, Steven E., additional, Colegrove, Lynn, additional, Coleman, Christina, additional, Colson, Angie, additional, Correa, Adolfo, additional, Costa, Pamela, additional, Couser, Chris, additional, Crenshaw, Melissa Lynnn, additional, Crume, Tessa, additional, Daskalov, Rachel, additional, Del Monte, Mark D., additional, DeSantis, Lindsay, additional, Doherty, Kaitlin, additional, Dooley, Kenneth, additional, Duke, Charles (Wes), additional, Eghtesady, Pirooz, additional, Elayda, Saiza, additional, Ellison, Alison, additional, Elsner, Tim, additional, Erntz, Cori, additional, Esquivel, Michelle Z., additional, Evans, Bethany, additional, Feit, Lloyd Robert, additional, Feldkamp, Marcia, additional, Foley, William, additional, Foster, Elyse, additional, Franklin, Wayne, additional, Freeley, Bridget, additional, Galioto, Frank M., additional, George, Mary, additional, Gewitz, Michael H., additional, Gist, Katja Michelle, additional, Glenn, Thomas, additional, Glidewell, Melissa (Jill), additional, Gore, Lorraine A., additional, Gray, Johanna, additional, Green, Hannah, additional, Gurvitz, Michelle Z., additional, Handa, Sonia, additional, Harvey, Melissa, additional, Heath, Emilie, additional, Hile, Danielle, additional, Hokanson, John Smith, additional, Honein, Margaret (Peggy), additional, Hubbell, Marius M., additional, Hudson, Jeff, additional, Huhn, Kelly, additional, Ilardi, Dawn, additional, Jacobs, Dawn C., additional, Jaquiss, Robert Douglas Benjamin, additional, Jenkins, Kathy J., additional, John, Anitha, additional, Johnson, Patrick, additional, Johnson, Shakila, additional, Jones, Emily, additional, Jossif, Antonios P., additional, Kaltman, Jonathan Ross, additional, Kasnic, David, additional, Kemper, Alex R., additional, Kenny, Natalie, additional, Khairy, Paul, additional, King, Valerie, additional, Knapp, Donna, additional, Kobayashi, Daisuke, additional, Kovacs, Adrienne, additional, Kucik, James, additional, Kuehl, Karen S., additional, Kuznetsov, Alexandra, additional, Leezer, Scott, additional, Lemacks, Jodi, additional, Libby, Patty, additional, Lipkin, Paul H., additional, Lloyd‐Puryear, Michele Ann, additional, Lopez, Keila Natilde, additional, Madsen, Nicolas L., additional, Mai, Cara, additional, Mann, Monica, additional, Marino, Bradley, additional, Martin, Gerard Robert, additional, Paul Matherne, G., additional, Mauller, Phillip, additional, May, Susan, additional, McCabe, Edward R. B., additional, McCabe, Nancy, additional, McCardle, Michelle, additional, McCathran, Ty, additional, McCathran, Amy, additional, McConnell, Michael E., additional, McCormick, Kristine Brite, additional, Melsom, Eric, additional, Milionis, William Kelly, additional, Miller, Paula, additional, Miller, Erika, additional, Mitchell, Stephanie, additional, Moore, Cynthia A., additional, Morris, Laura, additional, Murray, Angela, additional, Mussatto, Kathleen, additional, Neish, Steven R., additional, Nelson, Sue, additional, Newburger, Jane W., additional, Nicolarsen, Jeremy, additional, Niggles, Autumn, additional, Noonan, Jacqueline Anne, additional, Ober, Gail, additional, O'Keefe, Lori, additional, Overcash, Marc, additional, Page, Jennifer, additional, Park, Matthew Vaughn, additional, Patel, Mehul D., additional, Patel, Jasmin, additional, Pearson, Gail Denise, additional, Pellegrini, Cindy, additional, Pierce, Corrie, additional, Pinto, Nelangi M., additional, Polen, Kara, additional, Quinones, Jose Alcides, additional, Raimondi, Carol, additional, Richter, Pat, additional, Rintamaki, Michelle, additional, Robles, Elisa, additional, Rosenthal, Geoffrey L., additional, Rush, Grahame, additional, Russell, Laura, additional, Saarinen, Annamarie, additional, Sable, Craig Andrew, additional, Saltz, Joel, additional, Schaefer, Terri, additional, Schubert, Kathryn, additional, Schwartz, Vida, additional, Shapira, Stuart K., additional, Sheehan, Kathleen, additional, Silverman, Brenda, additional, Simeone, Regina, additional, Smith, Juanita, additional, Smith, Kimberly E., additional, Smith, Kristina, additional, Sontag, Marci, additional, Srivastava, Shubhika, additional, Stassen, Corrie, additional, Stiver, Corey, additional, Taubert, Kathryn, additional, Thibadeau, Judy, additional, Thomas, John P., additional, Thomas, Dena, additional, Thorne, Vivian Baldassari, additional, Tiernan, Linda, additional, Timmins, Susan, additional, Tiner, Colby, additional, Torentinos, Natalie, additional, Tringali, Glenn, additional, Tweddell, James S., additional, Vasquez, Lisa M., additional, Verstappen, Amy, additional, Ware, Janice, additional, Watkins, Caron, additional, Webb, Catherine L., additional, Weiss, Ellen, additional, Weiss, Marina, additional, Wernovsky, Gil, additional, Whitehurst, Gretchen, additional, Whitley, Herbert, additional, Witten, Jennifer, additional, Wong, Austin Henry, additional, Wright, Matthew, additional, Wynbrant, Robert, additional, and Zheleva, Bistra, additional

Published
2016
Full Text
View/download PDF

38. Variation in care practices across pediatric acute care cardiology units: Results of the Pediatric Acute Care Cardiology Collaborative (PAC3) hospital survey

Author

Hoerst, Amanda, Bakar, Adnan, Cassidy, Steven C., Clabby, Martha, Grippo, Erica Del, Graupe, Margaret, Harahsheh, Ashraf S., Hlavacek, Anthony M., Hart, Stephen A., Kipps, Alaina K., Madsen, Nicolas L., O’Neil, Dora D., Patel, Sonali S., Strohacker, Courtney M., and Tanel, Ronn E.

Abstract

The Pediatric Acute Care Cardiology Collaborative (PAC3) 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 PAC3project 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. 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). 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. The PAC3 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.

Published
2019
Full Text
View/download PDF

47. Abstract 11747: Variation in Chest Tube Duration and Length of Stay Across Centers in the Pediatric Acute Care Cardiology Collaborative (PAC3) and Pediatric Cardiac Critical Care Consortium (PC4).

Author

Bates, Katherine E, Khadr, Lara, Donohue, Janet, Crawford, Kari, Gaies, Michael G, Graupe, Margaret, Hanke, Samuel P, Hlavacek, Anthony M, Madsen, Nicolas L, Morell, Evonne, Pasquali, Sara K, Russell, Jennifer L, Schachtner, Susan K, Tanel, Ronn E, Ware, Adam L, and Kipps, Alaina K

Published
2018

48. Abstract 11376: Successful Reduction of Postoperative Chest Tube Duration and Length of Stay After Congenital Heart Surgery: A Multicenter Pediatric Acute Care Cardiology Collaborative (pac3) and Pediatric Cardiac Critical Care Consortium (pc4) Improvement Project

Author

Bates, Katherine E, Madsen, Nicolas L, Khadr, Lara, Graupe, Margaret, Hlavacek, Anthony M, Morell, Evonne, Pasquali, Sara K, Russell, Jennifer L, Schachtner, Susan K, Tanel, Ronn E, Ware, Adam L, Wooton, Sharyl, and Kipps, Alaina K

Abstract

Introduction:We previously found variation across congenital heart centers in postoperative chest tube (CT) management including one ?model? center with shorter CT duration and length of stay (LOS). It was unknown whether the model center?s approach of removing CTs earlier with higher volumes of output could be spread to other centers to reduce variation in CT management and improve outcomes. Using collaborative learning, we conducted a multicenter quality improvement (QI) project to decrease postoperative CT duration and LOS.Methods:PAC3and PC4data were collected on patients undergoing the 10 STS benchmark operations during the baseline phase (6/2017-6/2018) and intervention phase (7/2018-3/2019). Collaborative learning methods included review of best practices from the model site, regular data feedback on practices and outcomes, monthly webinars, and QI coaching, with an overall goal to reduce CT duration by 20%. Sites adapted CT removal practices (e.g. timing, volume criteria) from the model site to their local resources, practices, and setting. Statistical process control and traditional statistics were used to evaluate CT duration and LOS over time.Results:Overall 1767 patients from 9 centers were included. Patient characteristics did not differ between eras. Median CT duration decreased from 88.8 [IQR 48.1, 138.5] to 68.9 [IQR 44.5, 114.0] hours (p<0.0001). Median postoperative LOS decreased from 8 [IQR 5,14] to 7 [IQR 5, 11.5] days (p=0.0001). SPC analysis showed a decrease in CT duration and LOS in conjunction with the intervention phase, reported as mean per SPC standards (Figure). Rates of CT replacement (1.9% vs 2.1%, p = 0.40) and readmission for effusion did not change (1.2% vs 1.2%, p = 0.79).Conclusions:We successfully lowered postoperative CT duration and LOS across 9 centers using collaborative learning methodology. We plan to spread this project to other PAC3-PC4centers and will monitor for sustained improvement.

Published
2019
Full Text
View/download PDF

49. Abstract 13487: Lifelong Impact and Risk-Factors for Community Acquired Pneumonia in Congenital Heart Disease

Author

Evers, Patrick D, Farkas, Dora, Olsen, Morten, and Madsen, Nicolas L

Abstract

Introduction:The prevalence of congenital heart disease (CHD) in adults is rising globally necessitating a greater understanding of acquired diseases such as community acquired pneumonia (CAP), which remains a leading cause of age-related mortality and morbidity in the general population. We hypothesize that the CHD population, given at-risk cardiopulmonary mechanics and altered immune function, bears a uniquely high risk for CAP-related hospitalizations and subsequent mortality.Methods:A nationwide population-based cohort study using the Danish National Patient Registry was performed to calculate the cumulative incidence of CAP-hospitalizations and 30-day mortality amongst the adult CHD population, compared to 10 non-CHD persons matched by gender, birth year and adjusted for the presence of comorbidities using the Charleston Comorbidity Index. Cox proportional hazard regression quantified the impact of CHD severity and extracardiac defects.Results:The CHD cohort was 16,629 patients, born between 1890 to 1998. The majority had mild/moderate CHD, with 27.6% and 26.9% having a ventricular or atrial septal defect, respectively. The cumulative incidence of CAP-hospitalization (Figure) was higher for adults with CHD (HR 2.00; 95% CI: 1.83-2.18) than the comparison cohort. This risk was increased for those with extracardiac defects or a syndrome diagnosis (HR: 3.16; 95% CI: 2.36-4.23) as well as those with severe/univentricular congenital heart disease compared to non-CHD cohort (HR: 2.31; 95% CI: 1.89-2.82) and compared to those with mild/moderate CHD (HR: 1.20; 95% CI: 1.00-1.44). In addition, the 30-day CAP-associated mortality rate ratio was elevated above the control population in those less than 65 years of age (MMR: 1.70; 95% CI: 1.08-2.68).Conclusions:Adults with CHD are at elevated risk of CAP-hospitalization and associated mortality. This risk is further elevated in those with severe congenital heart disease and extracardiac defects.

Published
2019
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results