Implementation of a Coarctation Watch Clinical Practice Guideline: An Evidence-Based Quality Improvement Project

Background: Coarctation of the Aorta remains challenging to diagnose in the prenatal period. Coarctation of the Aorta (CoA) accounts for 5% of congenital heart disease in infants. Evidence shows that risk stratification and postnatal observation of infants with suspected Coarctation of the aorta improves the timely diagnosis of this disease. Local Problem: A Level III NICU in Utah has no guideline for the initial period of monitoring infants ³35 weeks gestation with prenatal suspicion of Coarctation of the Aorta, also known as Coarctation Watch. The lack of a standardized guideline has led to inconsistencies in clinical practice regarding the initial management of these infants. Methods: Pre- and post-intervention data were compared to evaluate the success of this quality improvement project. The surveys assessed staff practice and opinions before disseminating education and after implementing the Clinical Practice Guideline (CPG). Patient data was obtained with a retrospective chart review from January 2024 to October 2024 to look at clinical practice prior to implementation of the CPG. Interventions: This quality improvement project involved the implementation of a clinical practice guideline created by key stakeholders in Neonatology and Fetal Cardiology. A literature review was conducted to review best practice. Patient data was obtained with a retrospective chart review from January 2024 to October 2024 to look at clinical practice prior to implementation of the CPG. A survey was distributed to NICU caregivers assessing current practice and knowledge before implementation of the CPG. Education was disseminated to NICU caregivers, and CPG was implemented. 2 PDSA cycles were completed post-implementation for rapid change. A postimplementation survey assessed caregiver thoughts on feasibility, usability, and acceptability. Results: Key stakeholders with expert clinical opinion developed the clinical practice guideline. Approximately 200 caregivers received the surveys, with a 48% (n=96) pre-implementation response rate and a 16.5% (n=33) post-implementation response rate. 100% (n=33) of caregivers see the benefit of a standardized CPG for infants with suspected CoA. 77% (n=14) of providers report using this CPG in future clinical practice would be easy. And 83 % (n=15) see this CPG as useful in their continued practice. The identified barriers are that 21% (n=4) did not know there was a CPG, and 5.3% (n=1) could not locate the CPG. Conclusion: Although there was a low response rate to the post-implementation survey, most caregivers see the CPG as useable, feasible, and acceptable. The education and CPG are valuable resources for staff to improve the care of infants with prenatally suspected CoA. Following the interventions, ongoing collaboration with key stakeholders is crucial for successful implementation and sustainability.