Inpatient Health Care Utilization By Medically Complex Children Admitted to the Pediatric Intensive Care Unit

Much controversy has arisen in the last few decades regarding parental and family visitation in the intensive care setting. The greatest needs of parents while their child is in an intensive care unit include: to be near their child, to receive honest information, and to believe their child is receiving the best care possible. The barriers that exist to the implementation of open visitation mostly are staff attitudes and misconceptions of parental needs. Open visitation has been found in some studies to make the health-care providers’ job easier, decrease parental anxiety, and increase a child’s cooperativeness with procedures. To provide family-centered care in the pediatric intensive care unit, the family must be involved in their child’s care from the day of admission. As health-care providers, the goal is to empower the family to be able to advocate and care for their child throughout and beyond the life crisis of a pediatric intensive care unit admission

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Navigator-Based Intervention to Support Communication in the Pediatric Intensive Care Unit: A Pilot Study

American Journal of Critical Care ◽

10.4037/ajcc2020478 ◽

2020 ◽

Vol 29 (4) ◽

pp. 271-282

Author(s):

Kelly N. Michelson ◽

Elizabeth Charleston ◽

Danica Y. Aniciete ◽

Lauren R. Sorce ◽

Patricia Fragen ◽

...

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Health Care Team ◽

Care Team ◽

Care Needs ◽

Family Meetings ◽

Family Perceptions

Background Communication in the pediatric intensive care unit (PICU) between families and the health care team affects the family experience, caregiver psychological morbidity, and patient outcomes. Objective To test the feasibility of studying and implementing a PICU communication intervention called PICU Supports, and to assess families’ and health care teams’ perceptions of the intervention. Methods This study involved patients requiring more than 24 hours of PICU care. An interventionist trained in PICU-focused health care navigation, a “navigator,” met with parents and the health care team to discuss communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and checked in with parents after PICU discharge. The feasibility of implementing the intervention was assessed by tracking navigator activities. Health care team and family perceptions were assessed using surveys, interviews, and focus groups. Results Of 53 families approached about the study, 35 (66%) agreed to participate. The navigator met with parents on 71% and the health care team on 85% of possible weekdays, and completed 86% of the postdischarge check-ins. Family meetings were offered to 95% of eligible patients. The intervention was rated as helpful by 97% of parents, and comments during interviews were positive. Conclusions The PICU Supports intervention is feasible to implement and study and is viewed favorably by parents.

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Palliative care and end-of-life health utilization in elder patients with pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.488 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 488-488

Author(s):

Nizar Bhulani ◽

Ang Gao ◽

Arjun Gupta ◽

Jenny Jing Li ◽

Chad Guenther ◽

...

Keyword(s):

Health Care ◽

Pancreatic Cancer ◽

Intensive Care Unit ◽

Palliative Care ◽

Intensive Care ◽

Health Care Utilization ◽

End Of Life ◽

Cancer Patients ◽

Cost Of Care ◽

Care Utilization

488 Background: Prospective trials have shown that palliative care is associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients. Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room and Intensive Care utilization and costs in the last 30 days of life were assessed. Statistical analyses were performed with SAS version 9.4 (SAS Institute, Inc., Cary, NC). Results: Of the 72205 patients with pancreatic cancer, 3383 (4.1%) received palliative care. The proportion of patients receiving palliative care increased from 1.8% in 2000 to 7.8% in 2009 (p for trend < 0.001). Patients with palliative care were more likely to be Asian and women. Of those who received palliative care, 73% received it in the last 30 days of life, and only 11% at least 12 weeks before death. The average number of visits to the ED in the last 30 days of life were significantly higher for patients who received palliative care (0.93±0.62) versus those who did not (0.79±0.61), p < 0.001, and had a significantly higher cost of care ($1317 vs $842, p < 0.001). Intensive care unit length of stay in the last 30 days of life did not differ between patients who did and did not receive palliative care (1.14 days vs 1.04 days, p 0.08). Intensive care unit cost of care was significantly higher for patients with palliative care compared to their counterparts ($5202.641 vs $3896.750, p < 0.001). Conclusions: Palliative care use for pancreatic cancer patients has increased between 2000 and 2009 in this study of Medicare patients. However, it was largely offered close to the end of life and was not associated with reduced health care utilization or cost. Early palliative care referral may be more beneficial.

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Pediatric Intensive Care Unit Mortality Among Latino Children Before and After a Multilevel Health Care Delivery Intervention

JAMA Pediatrics ◽

10.1001/jamapediatrics.2014.3789 ◽

2015 ◽

Vol 169 (4) ◽

pp. 383 ◽

Cited By ~ 11

Author(s):

Kanwaljeet J. S. Anand ◽

Robert J. Sepanski ◽

Kimberley Giles ◽

Samir H. Shah ◽

Paul D. Juarez

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Health Care Delivery ◽

Intensive Care Unit Mortality ◽

Care Delivery ◽

Pediatric Intensive Care ◽

Latino Children ◽

Before And After

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Relationship Between Intensive Care Unit Delirium Severity and 2-Year Mortality and Health Care Utilization

American Journal of Critical Care ◽

10.4037/ajcc2020498 ◽

2020 ◽

Vol 29 (4) ◽

pp. 311-317

Author(s):

Patricia S. Andrews ◽

Sophia Wang ◽

Anthony J. Perkins ◽

Sujuan Gao ◽

Sikandar Khan ◽

...

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Health Care Utilization ◽

Mortality Risk ◽

Hazard Ratio ◽

Emergency Department Visits ◽

Care Utilization ◽

Increased Risk

Background Critical care patients with delirium are at an increased risk of functional decline and mortality long term. Objective To determine the relationship between delirium severity in the intensive care unit and mortality and acute health care utilization within 2 years after hospital discharge. Methods A secondary data analysis of the Pharmacological Management of Delirium and Deprescribe randomized controlled trials. Patients were assessed twice daily for delirium or coma using the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Delirium severity was measured using the CAM-ICU-7. Mean delirium severity (from time of randomization to discharge) was categorized as rapidly resolving, mild to moderate, or severe. Cox proportional hazards regression was used to model time to death, first emergency department visit, and rehospitalization. Analyses were adjusted for age, sex, race, Charlson Comorbidity Index, Acute Physiology and Chronic Health Evaluation II score, discharge location, diagnosis, and intensive care unit type. Results Of 434 patients, those with severe delirium had higher mortality risk than those with rapidly resolving delirium (hazard ratio 2.21; 95% CI, 1.35-3.61). Those with 5 or more days of delirium or coma had higher mortality risk than those with less than 5 days (hazard ratio 1.52; 95% CI, 1.07-2.17). Delirium severity and number of days of delirium or coma were not associated with time to emergency department visits and rehospitalizations. Conclusion Increased delirium severity and days of delirium or coma are associated with higher mortality risk 2 years after discharge.

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Perspectives of Pediatric Providers on Patients With Complex Chronic Conditions: A Mixed-Methods Sequential Explanatory Study

Critical Care Nurse ◽

10.4037/ccn2020710 ◽

2020 ◽

Vol 40 (5) ◽

pp. e10-e17

Author(s):

Taylor A. Kobussen ◽

Gregory Hansen ◽

Rebecca J. Brockman ◽

Tanya R. Holt

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Health Care Providers ◽

Chronic Conditions ◽

Pediatric Intensive Care ◽

Care Providers ◽

Complex Chronic Conditions ◽

Semistructured Interviews

Background Children with complex chronic conditions present unique challenges to the pediatric intensive care unit, including prolonged length of stay, complex medical regimens, and complicated family dynamics. Objectives To examine perspectives of pediatric intensive care unit health care providers regarding pediatric patients with complex chronic conditions, and to explore potential opportunities to improve these patients’ care. Methods A prospective mixed-methods sequential explanatory study was conducted in a tertiary medical-surgical pediatric intensive care unit using surveys performed with REDCap (Research Electronic Data Capture) followed by semistructured interviews. Results The survey response rate was 70.6% (77 of 109). Perspectives of health care providers did not vary with duration of work experience. Ten semistructured interviews were conducted. Eight overarching themes emerged from the interviews: (1) the desire for increased formal education specific to pediatric complex chronic care patients; (2) designation of a primary intensivist; (3) modifying delivery of care to include a discrete location for care provision; (4) establishing daily, short-term, and long-term goals; (5) monitoring and documenting care milestones; (6) strengthening patient and family communications with the health care team; (7) optimizing discharge coordination and planning; and (8) integrating families into care responsibilities. Conclusions Pediatric intensive care unit health care providers’ perspectives of pediatric patients with complex chronic conditions indicated opportunities to refine the care provided by establishing daily goals, coordinating discharge planning, and creating occasions for close communication between patients, families, and providers.

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