Wednesday, September 24, 2014

Caring for Kids in the CVICU

By Jeffrey Alten, M.D.

Dr. Alten is the Medical Director of the Pediatric Cardiovascular Intensive Care Unit at Children’s of Alabama, Medical Director of the Cardiac ECMO program and serves as Director of the Pediatric Cardiac Clinical and Translational Research Program at Children’s. He is an Associate Professor in the Department of Pediatrics, Division of Pediatric Critical Care, at UAB. He received his MD from the University of Missouri Columbia with additional training at Arkansas Children’s Hospital and Texas Children’s Hospital.

As a pediatric cardiac intensivist, I start each morning by making my rounds in the cardiovascular intensive care unit at Children’s of Alabama. It doesn’t sound out of the ordinary, except every other week I’m handling it from 500 miles away at my home office in St. Louis, Mo., from an app on my phone where I am able to interact with the physicians that are at the patients’ bedside. While I spend the other weeks in Birmingham on-site at the hospital, technology has given me the flexibility to live remotely while still ensuring the highest level of care for my patients.

That’s the power of mobility in healthcare: I can be hundreds of miles away or just in a meeting down the hall at the hospital, but thanks to an application on my phone, I never truly have to leave my patients’ bedsides. The ability to do mobile “rounds” in the unit has become a necessity. I can constantly monitor their conditions no matter where I am and work closely with my colleagues in Birmingham to know exactly what is happening and catch minor deteriorations that could become life-threatening situations.

Most children we care for have congenital heart disease, and about 70 percent of them are awaiting, or have had heart surgery. The rest have acquired heart disease such as myocarditis or cardiomyopathy. While heart conditions at any age can be dangerous, pediatric cardiac conditions are even more dangerous and need careful monitoring because children don’t have the physiological reserve that adults do. With adults, and even children without cardiac disease, a slight delay in recognition of subtle clinical deterioration can often be managed without detriment to the patient. However, we don’t have this luxury in children with heart disease – each second is precious and critical.

The complex and tenuous condition of our patients requires an “all hands on deck” approach – true multidisciplinary team management to have the best outcome. It is comforting to know that our patients all have the ability to have multiple experts “at the bedside” consulting 24/7, 365 days a year. Whether it be a cardiologist evaluating a new arrhythmia in real time or another cardiac intensivist helping the doctor in the CVICU through a crisis by monitoring the child’s response to resuscitation in the middle of the night –mobile technology definitely improves the safety of our patients in the CVICU.

Ultimately, the goal is to prevent the subtle decline of our patients’ conditions and avoid the snowball effect that could end in cardiac arrest. With multiple eyes watching our patients every day, small changes in temperature, breathing indices, and cardiac pressures are more likely to be noticed and communicated before a dangerous change in condition occurs.

Mobility has given us the flexibility to care for patients when we can’t be at the bedside, the resources to make clinical decisions with all the facts, and the comfort that we can address issues as quickly as possible. From my office in St. Louis, I can participate in a team-based management plan and keep my patients safe. It’s all about early recognition and management before it becomes a problem — like the saying, “a stitch in time saves nine.”

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