P2D198: Increasing Reliability and Timeliness of Appropriate Genetic Consultation in the Pediatric Cardiac Intensive Care Unit

Purpose/Objectives: Cardiovascular genetics care is imperative to understanding patient prognosis, anticipated comorbidities, and pertinent counseling. Appropriate genetics consultation in our cardiovascular intensive care unit (CICU) has been inconsistent and provider-dependent, preventing equitable access to patient centered care. Therefore, our project aimed to increase the percentage of genetic counselor (GC) consults for eligible patients admitted to the CICU from 76% to 90% by December 2023. Our secondary aim was to decrease the time to GC consult on eligible CICU patients from 6 days to 3 days.

Design/Methods: A multi-disciplinary team of genetic counsellors, cardiologists, and quality improvement (QI) specialists utilized the Model for Improvement to design and implement interventions to optimize cardiovascular genetics care in our CICU. Patients were included based on a previously established algorithm for those that would benefit from a cardiovascular GC consultation while admitted, based on their cardiac presentation. A key driver diagram was created to establish barriers and guide potential actions to overcome them. The initial intervention was building an automated alert in our electronic medical record (EMR) based on the above-mentioned algorithm. The team then worked towards standardization in the CICU patient admit process to input more accurate diagnostic ICD-10 codes, and this was followed by supplying the nursing team with materials to educate families on the role of GC consultation.

Results: GC consults went from 76% in the pre-intervention period of January 2020 through June 2022 to 90% in the post-intervention period of July 2022 to March 2023 (Figure 1). Days to consult went from 6 days from January 2021 through June 2022 to 3 days from July 2022 to March 2023 (Figure 2). Prospective tracking of consultations with process control charts has allowed for prompt identification of outliers and their causes, such as onboarding new counselors and ongoing input delay or incorrect ICD-10 entry.

Conclusion/Discussion: Our improvement work demonstrates that eligible patients can be more reliably and promptly identified for GC consult by leveraging the EMR and partnering with frontline staff. Future efforts, such as continuing to streamline the workflow and ultimately expanding the patient population, are being made to ensure every eligible patient receives GC consultation to offer support, education, and resources to patients and families.