(761) Thinking Outside the (Heart) Box: Rehabilitation and Recovery Rounds in a Pediatric Cardiac ICU

Introduction: Critically ill children with heart failure (HF), ventricular assist device (VAD), or heart transplantation (HTx) admitted to cardiac intensive care unit (CICU) have complex and chronic multisystem disease. Other than cardiac rehabilitation, screening, management of chronic non-cardiac medical conditions is not described in this population. We report the feasibility, efficacy of multidisciplinary rehabilitation and recovery rounds (RRR) in the pediatric CICU to improve screening, monitoring of non-cardiac health conditions.

Methods: HF/VAd/HTx patients 0 -21 yrs old admitted to CICU with an index hospitalization > 2 weeks met criteria. Multidisciplinary team of critical care providers, physical medicine and rehabilitation (PM&R) physicians, occupational therapists (OT), physical therapists (PT), speech and language pathologists (SLP), and critical care nurses conduct RRR every 2 weeks, with family if available. Rounding script: family/nurse reported non-cardiac concerns; therapy goals for next 2 weeks; eligibility for mental health screening (PROMIS); immunization needs; vitamin D screen, need for PM&R/SLP consultation, barriers to OT/PT goals. Process measures: % eligible pts rounded on; % of eligible pts receiving PROMIS. Outcome measures: number of new SLP and PM&R consults indexed to no. of pts rounded. Balancing measures: family and nurse satisfaction surveys.

Results: RRR launched in April 2023. Mean proportion of eligible pts rounded on: 90% (19 pts in 7 sessions). Average time per pt: 10.8min. 100% had goals on the whiteboards and 100% meeting mental health screening criteria received screening. 3 (15%) had Vit D screening, 5 (26%) pts received new PM&R consult and 1 SLP consult. 4 (21%) received catch-up immunizations. 5 surveys completed, (4 nurse, 1 family). 5/5 agreed/strongly agreed that RRR improved their understanding of their child's care plan/trajectory. Free text feedback included that RRR “bring attention to areas of care that are frequently overlooked” and “love how it provides not just medical care but focuses on the development of the specific patient”.

Conclusions: RRR is feasible, well-received addition to the care of critically ill children with HF/VAD/HTx. RRR identifies and addresses key gaps in rehabilitation and health maintenance needs in this complex population.