Reducing Routine Cardiology Evaluation Prior to Initiating Propranolol for Infantile Hemangiomas.
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OBJECTIVE: Determine if all patients with infantile hemangioma (IH) should undergo cardiology evaluation prior to initiating propranolol therapy or if only select patients should undergo cardiology evaluation, as indicated by a Propranolol Screening Checklist (PSC). METHODS: Retrospective review of 806 IH patients treated with propranolol between 2008 and 2018 at a single tertiary center. Statistical process control methods were used to compare the cardiology recommendations between the pre-PSC and post-PSC populations and there was special cause variation after implementation of the checklist. RESULTS: There were 527 (73.1%) patients referred for cardiology evaluation prior to propranolol initiation for IH before implementation of the PSC compared to 10 (11.5%) patients referred after PSC implementation (P < .001). There was less testing obtained from patients prior to initiating therapy, like echocardiograms and EKGs. No patients were prevented from initiating therapy throughout the time studied. DISCUSSION: Cardiology referral prior to initiating propranolol therapy for IH is unnecessary in otherwise healthy infants without concerning signs or symptoms. IMPLICATIONS FOR PRACTICE: Propranolol therapy can be instituted safely in most IH patients after screening for the need for cardiology referral. This improves efficiency for families and institutions with high complexity patients. This may avoid the long wait times for specialist care which delays this time-sensitive intervention.