Pediatric continuity care intensivist: A randomized controlled trial

Area of Science:

• Pediatric Critical Care Medicine
• Healthcare Quality Improvement
• Patient Communication

Background:

• Long-stay pediatric intensive care unit (PICU) patients face risks of inconsistent care and poor communication.
• Continuity of care and effective communication are crucial for improving outcomes in critically ill children.

Purpose of the Study:

• To develop and evaluate an intervention aimed at enhancing care continuity and communication for long-stay PICU patients.
• To assess the impact of a Continuity Care Intensivist (CCI) on patient outcomes, parental satisfaction, and intensivist perceptions.

Main Methods:

• A randomized controlled trial was conducted in a single PICU, randomizing patients to the intervention or control group.
• The intervention involved assigning a dedicated Continuity Care Intensivist (CCI) to provide consistent care and communication.
• Outcomes included PICU length of stay, ventilator-dependent days, hospital-acquired infections, parental mood/satisfaction, and intensivist feedback.

Main Results:

• The intervention focused on standardizing the CCI role, ensuring consistent team and family contact, and improving decision-making timeliness.
• Analysis included intention-to-treat using multivariable linear regression to determine intervention impact.
• Challenges identified include defining appropriate enrollment criteria and managing prognostic uncertainty for long-stay patients.

Conclusions:

• The CCI intervention shows promise for improving care continuity and communication in the PICU setting.
• Further research is needed to refine patient selection and optimize the CCI role for maximum impact.
• Lessons learned highlight the complexities of implementing continuity interventions in the PICU.