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care provider ■ Face-to-face dialog is ideal, but more practically this conversation occurs via phone ■ Anticipatory guidance and the creation of a shared care model specifically as it relates to home monitoring data, scheduled visits, immunizations, and management during commonly acquired infant illness ■ Parent participation in care hand-off from inpatient to outpatient setting can shorten and improve initial outpatient encounters, highlight parent presence in the shared care model, and lessen the potential stress and anxiety that occurs with discharged home ■ Written documents supplied to outpatient care teams Paper-based or electronic documents serve as a resource to outpatient care teams and provide both essential and supplemental information to complement the verbal hand-off ■ Transfer of professional responsibility Clear understanding of shared patient management among the outpatient cardiologist team, primary care provider, and interstage management team is essential Outpatient Management Home Monitoring Rationale for home monitoring of oxygen saturations and weight trends are detailed earlier Call criteria or red flags indicating potential physiologic concern need to be established by the interstage team and clearly shared with parents Criteria that warrant notification of the interstage care team include: ■ SpO2 less than 75% or greater than 90% ■ Weight loss of 30 g or failure to gain 20 g over 3 days ■ Enteral intake less than 100 mL/kg per day ■ Fever, cough, congestion, change in breathing pattern, vomiting, diarrhea, irritability Initial triage by the interstage care team may result in any of the following: ■ Weight or oxygen saturation recheck in-home (same day) ■ Clinical assessment by primary care provider or referring cardiologist (same day) ■ Interstage care team examination within 24 hours ■ Emergency department assessment ■ Direct admission to hospital Parent commitment to daily assessment and trending of weight and oxygen saturation values, the ability to identify change if clinical status warranting further assessment, and timely communication of concerns to the medical team is vital to the success of any interstage home monitoring program Nearly half of the infants who are enrolled in home monitoring programs are readmitted to the hospital during the interstage period.4,45 Over the course of 10 years, breach of home monitoring oxygen saturation and weight criteria alone occurred at least once in 86% of infants and were observed at similar rates between the modified Blalock-Taussig-Thomas shunt and the right ventricle to pulmonary artery conduit (Fig 72.5) Pulse oximetry less than 75% was the most common reason for breach of criteria, with a respiratory illness accounting for 28% of event and an anatomic cause for 24% Anemia was found in 9% of events Thirty percent of events related to oxygen saturation monitoring could not be categorized Breach of weight criteria accounted for approximately 40% of interstage events and resulted from inadequate enteral intake in nearly half of the monitored infants An example of interstage management when home monitored criteria were breached is shown in Fig 72.6.3