Multidisciplinary coordination of care for children with esophageal atresia and tracheoesophageal fistula.
Jody M Platt, Alberto Nettel-Aguirre, Candice L Bjornson and 3 others
PMID 37224564WHAT IT FOUND
Children with esophageal atresia or tracheoesophageal fistula in a multidisciplinary clinic had fewer subsequent hospital admissions, shorter subsequent stays, and fewer procedures in early childhood than an earlier cohort.
This is association, not proof the clinic caused the changes.
Key findings
01Subsequent admissions and length of stay per admission were statistically significantly lower in the clinic cohort, especially in the first two years.
02Total procedures per patient were significantly lower in the clinic cohort in the first two years: mean totals were 2.4 (SD 2.8) in year 0 to 1 and 0.7 (SD 1.7) in year 1 to 2, with reported differences of -4.39 and -2.36 versus the earlier cohort.
03Median providers per visit ranged from 3.17 (IQR 1.19) to 4.60 (IQR 0.82), and nurses and dietitians provided telephone assessments and advice to families, although not all telephone contacts were recorded.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a single-center study with a small sample, so the results may not apply to other centers. The clinic cohort was compared with a historical cohort, not a concurrent control group, so time-related changes in surgical technology and hospital care may explain the differences. The authors state causation cannot be determined because many variables may confound the relationship. Emergency department visits did not show a statistically significant difference between groups. Initial hospital length of stay was longer on average in the newer cohort, though not statistically significant. Quality of life and full economic impact were not compared because they were not measured in the previous cohort. Telephone contacts were not consistently recorded.
Declared interests
The authors declared no potential conflicts of interest and received no financial support for the research, authorship, or publication.
The easy way to misread this
Do not read the lower admissions and procedures as proof that the clinic caused them. The study compared a historical cohort, and the authors say causation is not possible because surgical technology, hospital care, and other changes over time cannot be controlled. Also, the clinic included many professions, so no single profession can be credited.