The Impact of a Pediatric Continuity Care Intensivist Program on Patient and Parent Outcomes: An Unblinded Randomized Controlled Trial

Authors

Jennifer K. Walter, Department of Pediatrics at Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, Pennsylvania, United States.
Vanessa Madrigal, Department of Pediatrics, Pediatric Critical Care Medicine, Children's National Hospital and George Washington University, Washington, D.C., United States.
Parth Shah, Perelman School of Medicine, Philadelphia, Pennsylvania, United States.
Sherri Kubis, Cardiac Nursing at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.
Adam S. Himebauch, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania, United States.
Chris Feudtner, Department of Pediatrics at Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, Pennsylvania, United States.

Document Type

Journal Article

Publication Date

6-1-2024

Journal

Journal of pediatric intensive care

Volume

13

Issue

2

DOI

10.1055/s-0041-1740360

Keywords

chronic illness; communication; continuity of care; length of stay; pediatric intensive care unit; randomized clinical trial

Abstract

We studied the impact of a standardized continuity care intensivists (CCIs) program on patient and family outcomes for long-stay patients in the pediatric intensive care unit (PICU), also assessing the intervention's acceptability and feasibility.  A patient-level, unblinded randomized-controlled trial in a PICU at a large children's hospital. Participants included: (1) patients with ≥ 7 days PICU admission and likely to stay another 7 days; (2) their parents; (3) PICU attendings participating as continuity attendings; and (4) PICU attendings providing usual care (UC). We examined a bundled intervention: (1) standardized continuity attending role, (2) communication training course for CCI, and (3) standardized timing of contact between CCI and patient/family.  Primary outcome was patient PICU length of stay. Secondary outcomes included patient, parental, and clinician outcomes. We enrolled 115 parent-patient dyads (231 subjects), 58 patients were randomized into treatment arm and 56 into the UC arm. Thirteen attendings volunteered to serve as CCI, 10 as UC. No association was found between the intervention and patient PICU length of stay (  = 0.5), other clinical factors, or parental outcomes. The intervention met a threshold for feasibility of enrollment, retention, and implementation while the majority of providers agreed the intervention was acceptable with more efficient decision making. Thirty percent CCIs felt the role took too much time, and 20% felt time was not worth the benefits.  CCI intervention did not impact patient or family outcomes. PICU attendings believed that the implementation of the CCI program was feasible and acceptable with potential benefits for efficiency of decision making.

APA Citation

Walter, Jennifer K.; Madrigal, Vanessa; Shah, Parth; Kubis, Sherri; Himebauch, Adam S.; and Feudtner, Chris, "The Impact of a Pediatric Continuity Care Intensivist Program on Patient and Parent Outcomes: An Unblinded Randomized Controlled Trial" (2024). GW Authored Works. Paper 5169.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5169

Department

Pediatrics