Acceptability of a Parental Early Warning Tool for Parents of Infants with Complex Congenital Heart Disease: a Qualitative Feasibility Study

Aim To explore the acceptability and feasibility of a parental early warning tool, called the Congenital Heart Assessment Tool (CHAT), for parents going home with their infant between first and second stage of surgery for complex congenital heart disease.
Background Home monitoring programmes were developed to aid early recognition of deterioration in fragile infants between first and second surgical stage. However, this necessitates good discharge preparation to enable parents to develop appropriate knowledge and understanding of signs of deterioration to look for and who to contact.
Design This was a longitudinal qualitative feasibility study, within a constructivist paradigm. Parents were taught how to use the CHAT before taking their infant home and asked to participate in semi-structured interviews at four timepoints: before discharge [T0]; two weeks after discharge [T1], eight weeks after discharge [T2] and after stage two surgery [T3]. Interviews were transcribed verbatim and thematically analysed.
Setting One tertiary children’s cardiac centre in the UK
Subjects Twelve parents of eight infants who were discharged following first stage cardiac surgery for complex congenital heart disease, between August 2013 and February 2015
Results: Four main themes emerged: 1) parental preparation and vigilance; 2) usability; 3) mastery; 4) reassurance and support.
Conclusions: The study highlighted the benefit of appropriately preparing parents before discharge, using the CHAT, to enable identification of normal infant behaviour and to detect signs of clinical deterioration. The study also demonstrated the importance of providing parents with information about when and who to call for management advice and support.