Multidisciplinary team
The RCP is run by a multidisciplinary team of therapy experts, supplementing the care that each child receives from their primary paediatrician and paediatric cardiologist.
The team includes:
While many children may have received a full repair of their heart defect, there will frequently be many issues related to either their pre- or post-operative journey that will require intensive input from therapy professionals both during and after their admission. These problems, all of which can increase the length of a child’s stay in hospital, include malnutrition, developmental weakness and delay, and feeding or swallowing difficulties.
Active therapy
“Acute phase rehabilitation” is the priority of the RCP. Active therapy starts during the inpatient stay, through intensive rehabilitation therapy where the therapist will involve the family so that they can continue working with the child once they are back at home. Patients will also be monitored either through weekly Royal Brompton or Harefield hospital-based therapy clinics or when they attend consultant appointments. This reduces the number of outpatient appointments the child needs to attend.
A key objective of the RCP is that patients are reviewed at the right time by therapists who specialise in children’s congenital heart disease and who have been involved in the full course of each patient’s admission.
High-risk conditions
Royal Brompton’s medical and surgical teams have identified the defects and palliative procedures that they consider to be at the greatest risk from feeding and developmental difficulties, all of which could significantly impact on the patient’s post-operative outcome.
These are:
- AVSD (atrioventricular septal defect)
- VSD (ventricular septal defect)
- PA banding (pulmonary bands for children awaiting VSD closure at a later stage)
- Tetralogy of fallot repair
- Hypoplastic left heart
- Myocarditis
The majority of these defects are surgically corrected within the first three months of life using procedures that accounted for approximately 30 per cent of paediatric cardiology surgeries performed at Royal Brompton Hospital in 2013.
There is a significant body of evidence that indicates infants with congenital heart defects are at risk of malnutrition. Therefore, the surgical team will carefully consider every child’s growth and developmental progress before deciding on the timing and type of corrective surgery needed.
Many local rehabilitation services are under immense pressure and have long waiting times, in some cases, even for urgent referrals. Any delay to therapy intervention will, potentially, have a huge and negative effect on surgical outcomes, and consequently, on the infant. It is more effective for the patient to receive advice from cardiology therapy staff who have the specialist knowledge that is required to manage these patients safely and effectively i.e. being aware of fluid restrictions and the risks of heart failure. This is where Royal Brompton’s paediatric rehabilitation programme will have the greatest benefit.
Benefits of the service
- Specialist team members are giving the right advice and intervention at the right time
- Parents, family members and carers are empowered to take a confident and active role in their child’s rehabilitation care
- Reduced pressure on local therapy services.
