Congenital heart defects (CHD) are considered one of the leading death causes in childhood and continue to be a major public health problem worldwide. In our country, the complexity of CHDs and a cost-constrained healthcare environment makes their care challenging.
In 1996 “Proyecto de Todo Corazón” started as a pediatric cardiac program. Its mission: provide the best quality of medical and nursing care at the lowest possible cost. Clinical, economic, and human resource factors based on family-centered care principles were considered to ensure quality outcomes. Clinical pathways were applied to analyze procedures and protocols. Funding could be obtained from external private sources.
From April 1999 until December 2005, 3445 children were evaluated, 662 underwent surgery.
On February 2006, the new goal was to transfer our experience to another Pediatric facility. A satellite program was started in Maracaibo. A team of fully trained cardiac physicians, nurses and perfussionists travelled monthly from Caracas. Nurses adopt different roles (cross-training between operating room, Anesthesia and Pediatric ICU). Special care guaranteed early extubation, short-term Intensive Care and hospital stay.
From February 2006 to December 2008, 204 surgeries were performed in 80 surgical days (mean 2,5 patients/day). Mortality 7/204(3,4%): on-pump: 140 (69%) peripherals: 64(31%).
Ongoing review of clinical pathways, evidence-based modifications of clinical paradigms and good teamwork leads to cost reduction, new solutions and improvement of a pediatric cardiac program in a cost-constrained environment. It allows to create satellite programs to perform heart surgery for a broader population in the same country.