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Pediatric Chronic Critical Illness: Gaps in Inpatient Intrateam Communication
Ryan S Hirschfeld1, Silvana Barone2, Emily Johnson1
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Inpatient communication for children with complex medical needs is fragmented, lacking collaboration and continuity. Improving team communication and skills is crucial for better care of these vulnerable patients.
Area of Science:
- Pediatric Healthcare
- Healthcare Communication
- Medical Complexity
Background:
- The number of children with medical complexity and prolonged hospitalizations is increasing.
- Current acute care strategies are insufficient for the growing clinical demand.
- Effective team communication is vital for managing these complex cases.
Purpose of the Study:
- To assess inpatient team communication practices for children with prolonged hospitalizations.
- To identify alignment between current practices and team needs.
- To pinpoint areas for communication improvement.
Main Methods:
- A cross-sectional mixed-methods survey was conducted.
- Participants included interdisciplinary healthcare professionals at an academic children's hospital.
- Data were collected from 408 participants (33% response rate).
Main Results:
- Three themes emerged: dysfunctional team collaboration, continuity gaps, and inadequate communication skills/tools.
- Inconsistent meetings and lack of consensus hindered collaboration.
- Time-limited rotations and absent leaders impacted continuity and shared decision-making.
- Professionals reported insufficient training for complex conversations and conflict resolution.
- Intra-team conflict was more common in caring for these children.
- Intensive care unit (ICU) providers found care more stressful.
Conclusions:
- Inpatient communication must be adapted for longitudinal care of children with prolonged hospitalizations.
- Priority areas for improvement include enhancing collaboration, continuity, and communication skills.
- Modified acute care approaches are necessary to meet clinical demand.
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.
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