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Impact of subspecialty consultations on diagnosis in the pediatric intensive care unit
Sonali Ramesh1, Brennan Ayres2, Patrick Ten Eyck3,4
1Department of Pediatrics, BronxCare Health System, New York, NY, USA.
Insights
Subspecialty consultations are common in pediatric intensive care units (PICUs) and significantly impact diagnosis and treatment for critically ill children. This collaboration is vital for effective patient care.
Area of Science:
- Pediatric Critical Care Medicine
- Medical Subspecialties
- Healthcare Collaboration
Background:
- Intensivists and subspecialists frequently collaborate in diagnosing patients within the pediatric intensive care unit (PICU).
- Understanding the role and impact of these consultations is crucial for optimizing care for critically ill children.
Purpose of the Study:
- To characterize critically ill children requiring subspecialty consultations in the PICU.
- To describe the characteristics of these consultations.
- To determine the impact of subspecialty input on the final PICU diagnosis.
Main Methods:
- A retrospective chart review was conducted in a single tertiary referral PICU.
- Data were collected on patients admitted for acute illness, comparing those with and without subspecialty consultations within the first three days.
- Changes in diagnostic evaluation or treatment following consultations were assessed.
Main Results:
- Subspecialty consultations were requested for 86% of patients (152 consultations for 87 of 101 patients).
- Consultations influenced diagnosis in 21% of cases, with subspecialty input being key in 61% of these changes.
- Consultations led to further diagnostic testing in 45% and immediate treatment changes (medications, procedures) in 55% of cases.
Conclusions:
- Subspecialty consultations are a common and influential component of care in the PICU.
- These collaborations can significantly impact the diagnosis and treatment of critically ill children.
- Further research into interdisciplinary collaboration in the PICU is essential for effective teamwork in diagnosis.
Objectives:
Intensivists and subspecialists often collaborate in diagnosing patients in the pediatric intensive care unit (PICU). Our objectives were to characterize critically ill children for whom subspecialty consultations were requested, describe consultation characteristics, and determine consultations' impact on PICU diagnosis.
Methods:
We performed a retrospective study using chart review in a single tertiary referral PICU including children admitted for acute illness. We collected data on patients with and without subspecialty consultations within the first three days of PICU admission and determined changes in PICU clinicians' diagnostic evaluation or treatment after consultations.
Results:
PICU clinicians requested 152 subspecialty consultations for 87 of 101 (86%) patients. Consultations were requested equally for assistance in diagnosis (65%) and treatment (66%). Eighteen of 87 (21%) patients with consultations had a change in diagnosis from PICU admission to discharge, 11 (61%) attributed to subspecialty input. Thirty-nine (45%) patients with consultations had additional imaging and/or laboratory testing and 48 (55%) had medication changes and/or a procedure performed immediately after consultation.
Conclusions:
Subspecialty consultations were requested during a majority of PICU admissions. Consultations can influence the diagnosis and treatment of critically ill children. Future research should investigate PICU interdisciplinary collaborations, which are essential for teamwork in diagnosis.
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