First name
Sherri
Last name
Kubis

Title

Pediatric continuity care intensivist: A randomized controlled trial.

Year of Publication

2018

Date Published

2018 Nov 20

ISSN Number

1559-2030

Abstract

<p><strong>INTRODUCTION: </strong>Long-stay critically ill patients in the Pediatric Intensive Care Unit (PICU) may be at risk for inconsistencies in treatment plan, delay in plan progression, and patient/family dissatisfaction with communication. This article describes the development and evaluation of an intervention designed to improve continuity and communication delivered by continuity PICU attendings.</p>

<p><strong>METHODS AND ANALYSIS: </strong>A randomized controlled trial of an intervention in one PICU that was randomized at the patient level. Eligible patients and their parents included those admitted to the PICU for longer than one week and were anticipated to remain for an additional 7 days. The intervention, a Continuity Care Intensivist (CCI), included early assignment of a continuity attending (separate from a regularly scheduled service attending), standardization of the continuity role to ensure consistent team and family contact and facilitate timely decision making, and enhancement of CCI communication skills. The outcomes evaluated were 1) patient PICU length of stay, ventilator-dependent days, and hospital acquired infections, 2) parental mood and satisfaction with PICU communication, and 3) intensivist perception of acceptability of intervention. Intention to treat analysis will be completed using multivariable linear regression to determine the impact of the intervention on outcomes. Lessons have been learned about the appropriate enrollment criteria for patients to allow for impact of continuity attending, frequent prognostic uncertainty in determining which patients will become longer stay in the PICU, and the difficulty of achieving timely initial contact of continuity attending with patients given the CCI's other commitments.</p>

DOI

10.1016/j.cct.2018.11.011

Alternate Title

Contemp Clin Trials

PMID

30468772

Title

Beyond Reporting Early Warning Score Sensitivity: The Temporal Relationship and Clinical Relevance of "True Positive" Alerts That Precede Critical Deterioration.

Year of Publication

2018

Number of Pages

E1-E6

Date Published

2018 08 29

ISSN Number

1553-5606

Abstract

BACKGROUND: Clinical deterioration is difficult to detect in hospitalized children. The pediatric Rothman Index (pRI) is an early warning score that incorporates vital signs, laboratory studies, and nursing assessments to generate deterioration alerts.

OBJECTIVE: (1) Evaluate the timing of pRI alerts and clinicians recognizing deterioration or escalating care prior to critical deterioration events (CDEs) and (2) determine whether the parameters triggering alerts were clinically related to deterioration.

DESIGN: CDEs are unplanned transfers to the intensive care unit with noninvasive ventilation, tracheal intubation, and/or vasopressor infusion in the 12 hours after transfer. Using one year of data from a large freestanding children's hospital without the pRI, we analyzed CDEs that would have been preceded by pRI alerts. We (1) compared the timing of pRI alerts to time-stamped notes describing changes in patient status and orders reflecting escalations of care and (2) identified score component(s) that caused alerts to trigger and determined whether these were clinically related to CDE etiology.

RESULTS: Fifty CDEs would have triggered pRI alerts if the pRI had been in use (sensitivity 68%). In 90% of CDEs, the first clinician note reflecting change in patient status and/or the first order reflecting escalation of care preceded the first pRI alert. All of the vital sign and laboratory components of the pRI and 51% of the nursing components were clinically related to the etiology of the CDE.

CONCLUSIONS: Evidence that clinicians were aware of deterioration preceded pRI alerts in most CDEs that generated alerts in the preceding 24 hours.

DOI

10.12788/jhm.3066

Alternate Title

J Hosp Med

PMID

30156583

Title

Beyond Reporting Early Warning Score Sensitivity: The Temporal Relationship and Clinical Relevance of "True Positive" Alerts that Precede Critical Deterioration.

Year of Publication

2019

Number of Pages

138-143

Date Published

2019 Mar

ISSN Number

1553-5606

Abstract

BACKGROUND: Clinical deterioration is difficult to detect in hospitalized children. The pediatric Rothman Index (pRI) is an early warning score that incorporates vital signs, laboratory studies, and nursing assessments to generate deterioration alerts.

OBJECTIVES: (1) Evaluate the timing of pRI alerts and clinicians recognizing deterioration or escalating care prior to critical deterioration events (CDEs) and (2) determine whether the parameters triggering alerts were clinically related to deterioration.

DESIGN: CDEs are unplanned transfers to the intensive care unit with noninvasive ventilation, tracheal intubation, and/or vasopressor infusion in the 12 hours after transfer. Using one year of data from a large freestanding children's hospital without the pRI, we analyzed CDEs that would have been preceded by pRI alerts. We (1) compared the timing of pRI alerts to time-stamped notes describing changes in patient status and orders reflecting escalations of care and (2) identified score component(s) that caused alerts to trigger and determined whether these were clinically related to CDE etiology.

RESULTS: Fifty CDEs would have triggered pRI alerts if the pRI had been in use (sensitivity 68%). In 90% of CDEs, the first clinician note reflecting change in patient status and/or the first order reflecting escalation of care preceded the first pRI alert. All of the vital sign and laboratory components of the pRI and 51% of the nursing components were clinically related to the etiology of the CDE.

CONCLUSIONS: Evidence that clinicians were aware of deterioration preceded pRI alerts in most CDEs that generated alerts in the preceding 24 hours.

DOI

10.12788/jhm.3066

Alternate Title

J Hosp Med

PMID

30811318

Title

Effect of the Procalcitonin Assay on Antibiotic Use in Critically Ill Children.

Year of Publication

2018

Number of Pages

e430e46

Date Published

2018 May 15

ISSN Number

2048-7207

Abstract

<p>We retrospectively studied the effect of introducing procalcitonin into clinical practice on antibiotic use within a large academic pediatric intensive care unit. In the absence of a standardized algorithm, availability of the procalcitonin assay did not reduce the frequency of antibiotic initiations or the continuation of antibiotics for greater than 72 hours.</p>

DOI

10.1093/jpids/piy004

Alternate Title

J Pediatric Infect Dis Soc

PMID

29529219

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