TY - JOUR
T1 - Pediatric Chronic Critical Illness
T2 - Gaps in Inpatient Intrateam Communication
AU - Hirschfeld, Ryan S.
AU - Barone, Silvana
AU - Johnson, Emily
AU - Boss, Renee D.
N1 - Funding Information:
4Berman Institute of Bioethics, Baltimore, MD.Baltimore, MD. There is a rising number of children with chronic and life-threatening conditions in pediatric hospitals across Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21287.This work was performed at Charlotte Bloomberg Children’s Center Johns the United States (1–3). Children with chronic crit-Supported, in part, by grant from the Johns Hopkins Children’s Center ical illness (CCI) represent the sickest of these children and Pediatric Innovation Award. are dependent on medical technology, require multiple sub-Dr. Barone received other support from Clinical and Research Fellow- specialists, and have recurrent and prolonged ICU stays (2, 4). ship in Pediatric Palliative Care funded by the Stavros Niarchos Founda-Their complex inpatient management involves dozens if not Center, National Palliative Care Research Center, and Cambia Founda-tion. Dr. Boss’ institution received funding from Johns Hopkins Children’s hundreds of interdisciplinary healthcare professionals (HCPs) tion Sojourns Scholar Leadership Award. The remaining authors have dis- during a single hospitalization. closed that they do not have any potential conflicts of interest. Emerging data suggest that the quality of communication be-tween HCPs, and between HCPs and families, degrades during prolonged hospitalizations (5–7). A survey of family caregivers of adults with CCI found that as hospitalizations lengthen, fami-lies become less informed that mounting complications portend worsening functional status and prognosis (7). We have pre-viously shown that HCPs and parents believe that inadequate
Publisher Copyright:
© 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Objectives: The number of children with medical complexity and prolonged hospitalizations is rising. Strategies to adapt acute care approaches for this population are falling behind clinical demand. This study aimed to identify how inpatient team communication practices match the needs of teams caring for these patients and families, and to identify priority areas for improvement. Design: Cross-sectional mixed methods survey. Setting: Academic children's hospital. Subjects: Interdisciplinary healthcare professionals: Physicians, nurse practitioners, nurses, resident and fellow trainees, respiratory therapists, clinical pharmacists, occupational therapists, physical therapists, social workers, and child life specialists. Interventions: None. Measurements and Main Results: Four-hundred eight interdisciplinary healthcare professionals participated (33% response rate). Half (53%) worked in ICUs and 37% had greater than 10 years clinical experience. Three overarching themes emerged regarding communication during care of children with prolonged hospitalizations are as follows: 1) Dysfunctional team collaboration: The many involved healthcare providers for these children have inconsistent team meetings and few platforms for reaching clinical consensus; 2) Continuity gaps: Time-limited clinician rotations and no designated longitudinal clinical leaders undermine relationships with families and key elements of shared decision-making; and 3) Inadequate communication skills and tools: Healthcare professionals have inadequate training to address complex conversations and big picture concerns, and often default to daily management conversations. Nearly half (40%) perceived intra-team conflict to occur more commonly during care of these children compared with those with short hospitalizations, and many feel unskilled to address these conflicts. Healthcare providers working in ICUs were more likely than other healthcare providers to find care of children with chronic critical illness stressful "most of the time" (ICU 46%; 60/131 vs non-ICU 25%; 21/84; p = 0.02). Conclusions: Acute care inpatient communication practices require modification to meet the needs of healthcare professionals who provide longitudinal care to children with repeated and prolonged hospitalizations. Improvement strategies should prioritize building collaboration, continuity, and communication skills among healthcare professionals.
AB - Objectives: The number of children with medical complexity and prolonged hospitalizations is rising. Strategies to adapt acute care approaches for this population are falling behind clinical demand. This study aimed to identify how inpatient team communication practices match the needs of teams caring for these patients and families, and to identify priority areas for improvement. Design: Cross-sectional mixed methods survey. Setting: Academic children's hospital. Subjects: Interdisciplinary healthcare professionals: Physicians, nurse practitioners, nurses, resident and fellow trainees, respiratory therapists, clinical pharmacists, occupational therapists, physical therapists, social workers, and child life specialists. Interventions: None. Measurements and Main Results: Four-hundred eight interdisciplinary healthcare professionals participated (33% response rate). Half (53%) worked in ICUs and 37% had greater than 10 years clinical experience. Three overarching themes emerged regarding communication during care of children with prolonged hospitalizations are as follows: 1) Dysfunctional team collaboration: The many involved healthcare providers for these children have inconsistent team meetings and few platforms for reaching clinical consensus; 2) Continuity gaps: Time-limited clinician rotations and no designated longitudinal clinical leaders undermine relationships with families and key elements of shared decision-making; and 3) Inadequate communication skills and tools: Healthcare professionals have inadequate training to address complex conversations and big picture concerns, and often default to daily management conversations. Nearly half (40%) perceived intra-team conflict to occur more commonly during care of these children compared with those with short hospitalizations, and many feel unskilled to address these conflicts. Healthcare providers working in ICUs were more likely than other healthcare providers to find care of children with chronic critical illness stressful "most of the time" (ICU 46%; 60/131 vs non-ICU 25%; 21/84; p = 0.02). Conclusions: Acute care inpatient communication practices require modification to meet the needs of healthcare professionals who provide longitudinal care to children with repeated and prolonged hospitalizations. Improvement strategies should prioritize building collaboration, continuity, and communication skills among healthcare professionals.
KW - chronic critical illness
KW - communication
KW - interdisciplinary
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U2 - 10.1097/PCC.0000000000002150
DO - 10.1097/PCC.0000000000002150
M3 - Article
C2 - 31634307
AN - SCOPUS:85075962522
SN - 1529-7535
VL - 20
SP - e546-e555
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 12
ER -