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J Pediatr Intensive Care
DOI: 10.1055/s-0041-1740360
Original Article

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

Jennifer K. Walter
1   Department of Pediatrics at Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Vanessa Madrigal
2   Department of Pediatrics, Pediatric Critical Care Medicine, Children's National Hospital and George Washington University, Washington, D.C., United States
,
Parth Shah
3   Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Sherri Kubis
4   Cardiac Nursing at Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
,
Adam S. Himebauch
5   Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Chris Feudtner
1   Department of Pediatrics at Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, Pennsylvania, United States
› Author Affiliations Funding Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number K23HL141700. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Abstract

Objectives 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.

Methods 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.

Results 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 (p = 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.

Conclusion 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.

Keywords

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

Supplementary Material



Publication History

Received: 19 September 2021

Accepted: 24 October 2021

Article published online:
23 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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