Enhancing a Rehabilitation Pathway for Pediatric Heart Transplant Recipients: An Improvement Project to Increase Adherence, Satisfaction, and Outcomes

Abstract

Aims

To refine a cardiac rehabilitation pathway for pediatric heart transplant recipients; assess clinician knowledge and adherence to the program; and evaluate patient outcomes.

Methods

The center has utilized a rehabilitation pathway for pediatric heart transplant recipients. Challenges in practice include access to centers, lack of data tracing, and adherence to the pathway. The quality initiative focused on program refinements: implementation of text templates to improve data collection, collection of the Pediatric Cardiac Quality of Life Inventory (PCQLI), Functional Independence Measure (WeeFIM) and Child Occupational Self-Assessment (COSA), development of an outreach program, and creation of an educational program for therapists to increase content knowledge and improve clinician satisfaction.

Results

In the evaluation of rehabilitation follow-up post-transplant, there was no statistical significance between the pre- and post-implementation groups. After the implementation of the refined pathway, there was an increase in the completion of the six-minute walk test post-transplant (p = 0.048). Clinicians’ responses post educational session noted familiarity with the pathway (88%), documentation (78.8%), and outcome measures (97%). Results of outcomes noted improvement in six-minute walk distances and a decrease in the rate of perceived exertion post-transplant. To ensure future pathway adherence, clinical support should be implemented, and key players identified to maintain sustainability.

Keywords:

• Cardiac rehabilitation
• pediatric heart transplant
• rehabilitation pathway
• quality improvement

Acknowledgments

The authors would like to acknowledge the following personnel who developed and initiated the HEARTBEAT pathway: Unoma Akamagwuna MD, Daryaneh Badaly PhD, Elizabeth Betancourt PT, Lauren Farver DPT, Lynn Golightly SLP, Matthew Zinn DO.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Kristin Clarkson

Kristin Clarkson, DNP, RN, CPNP-AC, CRRN, is a pediatric rehabilitation medicine nurse practitioner and Assistant Professor at the University of Pittsburgh in the Health Promotion and Development department at the University of Pittsburgh School of Nursing. Her clinical emphasis is on inpatient rehabilitation medicine consultation, as well as ambulatory general rehabilitation management. Dr. Clarkson is a part of the clinical rehabilitation team that provides rehabilitation evaluation and services to the pediatric heart failure population in Pittsburgh, PA.

Brittany Amori

Brittany Amori, OTR/L, Occupational Therapist, is a graduate of the University of Pittsburgh earning her Master of Occupational Therapy degree in 2015. She was one of the original members of the HEARTBEAT program designing clinic assessment tools, inpatient cardiac protocols, and education for patients and caregivers. She participated in the quality improvement project completing pre and post-heart transplant evaluations in conjunction with physical therapy and pediatric rehabilitation medicine.

Megan Smutney

Megan Smutney, PT, DPT, is a pediatric physical therapist at UPMC Children’s Hospital of Pittsburgh. She is a 2019 graduate of The University of Pittsburgh's physical therapy program. She currently works in the outpatient pediatric setting and has pediatric acute care experience where she assisted with quality improvement work in the cardiac intensive care unit.

Maddie Chrisman

Maddie Chrisman, PT, DPT, is a Pediatric Physical Therapist and Adjunct Professor at the University of Pittsburgh in the Department of Physical Therapy. She graduated from the University of Florida with a Bachelor’s in Health Science and Columbia University with a Doctorate in Physical Therapy. She began her professional career at NYU Langone Health and Rusk Rehabilitation, eventually moving to Pittsburgh, Pennsylvania where she held a clinical leadership position at UPMC Children’s Hospital of Pittsburgh (CHP). During her time at CHP, she gained significant experience in quality improvement through collaboration with many different clinicians on many different quality-focused initiatives and received additional education from Cincinnati Children’s Hospital to refine and broaden her quality skill set. She currently holds a position in corporate services as an Improvement Specialist at The Wolff Center at UPMC, which provides her the opportunity to drive system quality goals by partnering with colleagues across the organization to improve health care delivery and the overall experience for patients and members.

Amit Sinha

Amit Sinha, MD, is a pediatric physiatrist at UPMC Children’s Hospital of Pittsburgh and medical director of its acute pediatric inpatient rehabilitation unit. He is an Assistant Professor in the Department of Physical Medicine and Rehabilitation at the University of Pittsburgh School of Medicine.

Brenda Cassidy

Brenda Cassidy, DNP, RN, CPNP-PC, is an Associate Professor and Vice Chair of Academic Affairs in the Health Promotion and Development department at the University of Pittsburgh School of Nursing. Her clinical emphasis is a pediatric primary care nurse practitioner, specializing in adolescent medicine, specifically adolescent sexual health care. As Director of the Pediatric and Neonatal Nurse Practitioner programs, Dr. Cassidy is responsible for nurse practitioner program development. She teaches pediatric content to DNP students at the school of nursing and mentors students in DNP projects to improve health outcomes for youth. Her scholarly work has focused on establishing an academic-service partnership for interdisciplinary education using an innovative faculty preceptor model, Diversity, Equity and Inclusion, LGBTQIA + health curriculum development, and improving HPV vaccine rates. Dr. Cassidy is active in clinical practice and precepts students in two sites including primary care and Adolescent Medicine.

Jackie Calhoun

Jackie Calhoun, DNP, RN, CPNP-AC, CCRN, is an Assistant Professor in the Health Promotion and Development department at the University of Pittsburgh School of Nursing. Jackie earned her MSN from Rush University in 2013, where she studied in the Pediatric Acute/Chronic Care Pediatric Nurse Practitioner program. She was first certified as a Pediatric Acute Care Nurse Practitioner by the Pediatric Nursing Certification Board in 2013. Dr. Calhoun earned her DNP in Health Systems Executive Leadership from the University of Pittsburgh in 2020. Dr. Calhoun is actively involved in several professional organizations, including the National Association of Pediatric Nurse Practitioners, and the Society of Critical Care Medicine, where she is a member of the Nursing, Pediatrics, and Pediatric Advanced Practice Provider sections. She serves as an Item Writer for the CPNP-AC certification exam administered by the Pediatric Nursing Certification Board. She is also a member of the American Association of Critical Care Nurses, the American Association of Colleges of Nursing, the National Organization of Nurse Practitioner Faculty, and Sigma Theta Tau, the International Honor Society of Nursing. She is currently a Pediatric Critical Care Nurse Practitioner in the PICU at the UPMC Children’s Hospital of Pittsburgh.