Continuity Strategies for Long-Stay PICU Patients: Consensus Statements From the Lucile Packard Foundation PICU...

Area of Science:

• Pediatric critical care medicine
• Healthcare management
• Patient care coordination

Background:

• Long-stay patients (LSPs) represent a growing, vulnerable, and resource-intensive population in pediatric intensive care units (PICUs).
• Effective care continuity strategies are crucial for optimizing outcomes in LSPs but are not well-defined.

Approach:

• A multidisciplinary panel, including parents and experts, utilized a modified RAND Delphi methodology.
• This involved a literature review, iterative online surveys, and a virtual conference to achieve consensus.
• The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess evidence quality and statement strength.

Key Points:

• Seventeen consensus statements were developed across five key areas: eligibility, initiation, responsibilities, and resources for implementation and sustainability.
• The evidence quality for these statements was generally low to very low, emphasizing the reliance on expert and parent experience.
• Conditional strength was assigned to the consensus statements, acknowledging the limited empirical data.

Conclusions:

• The developed consensus statements offer novel guidance for PICUs on operationalizing, implementing, and sustaining continuity strategies for LSPs.
• These statements aim to enhance the care of this complex and resource-intensive patient population.
• The panel also generated a comprehensive list of metrics for evaluating the effectiveness of these continuity strategies.