Background: Pediatric heart transplant (HTx) recipients have many risk factors for poor scar healing post-operatively, however this area has had limited study. Early intervention is key while the scar is still active and immature. Historically, there was no formalized referral process to occupational therapy (OT) for scar management education and intervention. We describe a novel quality improvement project to increase clinical team knowledge on scar management, to formalize the referral process, and to identify the education needs of patients and families so that timely, proactive scar management education is provided. 
Methods: In September 2024, frontline members of the HTx multidisciplinary team (cardiologists, nurse practitioners, nurse, registered dietician) were provided with education regarding scar healing and indications for OT referral with both pre- and post-knowledge testing using questionnaires. From July-September 2024, families of children who were within one year post-HTx were asked to participate in a questionnaire to explore their experiences and to understand their learning needs around scar management, including method of delivery.  
Results: Seven frontline team members received education with pre- and post-knowledge testing showing improved knowledge in identifying problematic scars, understanding risk factors to poor scar healing, indications and understanding of the OT role regarding scar management. 
Seven families were eligible to participate; 2 were out of province families who were unable to participate. Mean age at HTx of the 5 included patients was 9.2± 5y and median time at participation was 9.8 months post HTx (range 7-12 months). Responses were obtained from 5 caregivers and 2 patients (ages 10 and 16 years). All caregivers and patients reported receiving a) an appropriate amount of scar management education and follow up, and b) that they received timely education. Preferences for delivery of education (multi-select available) included: conversation in clinic (80% caregivers, 100% patients), in-person demonstration (60% caregivers, 50% patients) handout (20% caregivers, 0% patients), and a video demonstration (0% caregivers, 50% patients). No participants identified a group education session as being a helpful mode of education. 
Conclusion: Frontline team member education can be impactful on clinician knowledge of scar management which may allow for more effective education provision to families. While the group of caregivers and patients we approached were happy with the scar management education they received, responses suggest that a multi-modal approach may be preferred over the current uni-modal approach. The impact of implementation of this novel standardized education and scar management protocol in the highest risk first year post-HTx is currently under study and remains to be seen.