CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
103
necessary means to pursue care outside of their local community.
Follow up was successfully managed for several patients.
Conclusion:
The outreach clinic represents the first-ever successful
and sustained paediatric cardiology outreach clinic in Uganda. The
financial cost of the clinic is not over-burdensome, and the clinic
allows children to obtain much-needed subspecialty care. Efforts are
on-going to expand the number of patients served and to improve the
available diagnostic and therapeutic tools.
312: IMPACT OF AN INTEGRATED ELECTRONIC HEALTH
RECORD SYSTEM ON PAEDIATRIC CARDIOLOGY CLIN-
IC DOCUMENTATION AT A TERTIARY HEALTHCARE
FACILITY
Niels Giddins
1
, Nancy Drucker
1
, Scott Yeager
1
, Caridee Tang
2
1
University of Vermont, Burlington VT, USA
2
Center for Health Care Management, Fletcher Allen Health Care,
Burlington VT, USA
Background:
We hypothesised that the introduction of an electronic
health record system (EHR) in an ambulatory clinic setting would
significantly improve time-lines and uniform availability of paediat-
ric cardiology consultation reports.
Methods and Results:
Clinic report records of three full-time
paediatric cardiologists were reviewed from four consecutive typical
weeks (fully staffed for five days, not preceding prolonged physician
absence of over one week) immediately before rollout of an inte-
grated EHR and from four consecutive typical weeks one year later.
Pre-EHR reports (164 in total) were prepared from transcribed dicta-
tion with subsequent editing by a physician. Documentation methods
of post-EHR reports (159 in total) varied by physician. Total report
preparation time (RPT) was defined as the number of days from
patient visit to final signature and report release.
Conclusions:
Institution of an integrated EHR at this tertiary health-
care facility significantly reduced out-patient consultation report
preparation times on average over 65% (
>
1 week), and markedly
improved uniformity of practice among physicians, despite variable
documentation methods. Prior performance did not predict results
post-EHR. EHR benefits included improvements in patient care
communication with positive implications for referring provider
satisfaction and healthcare system fiscal performance.
402: PARENT EDUCATION AND DISCHARGE INSTRUC-
TION: THEMES FROM INDIA
Sandra Staveski
1
, Rosalind Conway
2
, Linda Franck
1
, Susan Kools
1
1
University of California at San Francisco School of Nursing, USA
2
Innova Heart Hospital, Hyderabad, India
Background:
Discharge teaching has been associated with improved
patient and family satisfaction and earlier recognition and treatment
of complications. Traditionally, in developing countries physicians
give orders and nurses carry out those orders. The role of the patient
and family discharge teaching is not typically within nurses’ scope of
practice. We hypothesised that Indian nurses can effectively expand
their role to include discharge teaching for parents after a child’s
cardiac surgery.
Methods:
Study participants were recruited from a tertiary paediat-
ric heart hospital in India. Paediatric cardiac nurses and parents of
children undergoing cardiac surgery were eligible to participate in
the qualitative aspect of this mixed-methods study. Study participant
interviews were conducted by the PI with assistance from a trained
Indian interpreter and translated into English. Methodological and
conceptual memos were developed and a multi-phase analysis
occurred. The research team read the text and open-coded data
according to themes. The thematic analysis included a group discus-
sion for salient themes among several researchers and coding by two
separate researchers. Salient themes were integrated into higher-
order categories and given conceptual labels. The meanings of these
categories were interpreted and validated by data illustration.
Results:
Three themes were generated from the study and included
role expansion, agency, and easing recovery for nurses and parents.
Nurses and parents reported taking an active role in contrast to their
previously passive role during a child’s transition to discharge. This
active role was described as satisfying to nurses and parents alike.
Conclusions:
Parent teaching offers an opportunity for nurses to help
parents care for their sick children.
490: IMPROVEMENT IN RESULTS AND PROGRESS OF
INDEPENDENT SURGERY WITH INTERNATIONAL
CO-OPERATION IN A SINGLE UKRAINIAN CENTRE
Igor Polivenok
2
, Christian Gilbert
1
, Frank Molloy
1
, Olga Buchneva
2
,
Jaroslav Schafer
2
, Mark Danton
1,3
, Darko Anic
1,5
, William Novick
1,4
1
International Children’s Heart Foundation, Memphis TN, USA
2
Institute of General and Urgent Surgery, AMS of Ukraine, Kharkov,
UKR
3
Children’s Hospital Glasgow, UK
4
University of Tennessee, Health Science Centre, USA
5
Rebro University Hospital, Zagreb, Croatia
Background:
Surgery for congenital heart disease has been slow
to develop in parts of the Ukraine. We describe the impact of our
four-year surgical collaborative assistance programme between the
International Children’s Heart Foundation (ICHF) and Institute of
General and Urgent Surgery, AMS of Ukraine, Kharkov.
Methods:
Data were analysed from ICHF and Kharkov databases
prior to and since commencement of assistance (era A: January 2000
to May 2008, era B: May 2008 to May 2012). We evaluated differ-
ences between era A and era B for: case volume per year, (
±
SD),
30-day/hospital discharge mortality, case complexity (RACHS-1
model), and RACHS adjusted standardised mortality ratio (SMR:
observed/expected mortality). For era B, we evaluated year by year
the number of collaborative operations where a Ukrainian surgeon
was the primary operator.
Results:
In era A, 154 surgeries were performed, mean annual case
volume was 17.3
±
4.8, with an overall mortality of 4.55% and an
SMR of 3.6. RACHS category 1 comprised 75% of the total. In era B,
361 surgeries were performed. Mean annual case volume increased
to 90.2
±
30.9 (
p
<
0.001) with higher case complexity, and an overall
mortality of 5.82% and SMR of 1.6. In era B, 237 surgeries were
performed during 16 trips, 124 between trips; 140/237 (59.1%) cases
were led by a Ukrainian surgeon with either the visiting surgeon
(87/140) or local surgeon assisting (53/140).
Conclusions:
An assistance partnership in the model applied
significantly reduced mortality, increased case volume and complex-
ity, and developed independent operating skills in an economically
disadvantaged centre in a relatively short time period. This model
of assistance to developing countries is not ‘surgical tourism’, and
should always be open to scrutiny and evaluation by proven clinical
and educational outcomes.
494: REAL-TIME MOBILE TELEMEDICINE USING SCAL-
ABLE VIDEO CODING FOR NEONATAL HEART DISEASE
Kotaro Oyama
1
, Takashi Sawai
1
, Akio Ikai
1
, Yuichi Fujino
2
, Hiroshi
Fujii
3
, Motohiro Takagi
3
1
Iwate Medical University, Japan
2
Future University Hakodate, Japan
3
NTT Cyber Space Laboratories, Japan
Background:
An efficient system of real-time telemedicine requires
being applicable to a variety of devices and networks that consult-
ing medical providers utilise. Scalable video coding (SVC) enables
a video stream to be broken into multiple resolutions, quality levels
and frame rates, and to be flexibly conformed to device capabilities
and network conditions. We evaluated the applicability of H.264/
SVC to neonatal tele-echocardiography and devised a system of real-
time mobile telemedicine using SVC for underserved and disaster
regions in east Japan.
