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Characterizing Team Structure in the Pediatric Intensive Care Unit
Miriam C Shapiro1,2, Priti P Shah3, Dori A Cross4
1Division of Critical Care Medicine, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota.
Insights
Pediatric intensive care unit (PICU) teams are dynamic, with members constantly changing. Understanding the structure and function of these complex care teams is vital for improving patient care, especially for long-stay patients (LSP).
Area of Science:
- Pediatric Intensive Care
- Healthcare Management
- Sociometry
Background:
- Complex and fluctuating care teams in the pediatric intensive care unit (PICU) hinder optimal patient care, particularly for long-stay patients (LSP).
- Understanding the structure and function of PICU care teams is crucial for addressing these challenges.
Purpose of the Study:
- To empirically define the dynamic composition of PICU care teams for both LSP and non-LSP.
- To analyze the differences in team composition and structure between long-stay and short-stay patients in the PICU.
Main Methods:
- Retrospective chart review of patients aged 0-21 years admitted to medical/surgical and cardiovascular PICUs.
- Patients categorized into long-stay (LOS > 7 days) and short-stay (LOS ≤ 7 days) groups.
- Sociometric network models used to visualize team composition and structure over time.
Main Results:
- 35 patients included: 20 long-stay and 15 short-stay.
- Sociometric network models visualized the complexity and dynamic nature of PICU team composition.
- Analysis focused on the number and specialty composition of teams for different patient groups.
Conclusions:
- PICU teams are highly dynamic, with constantly changing members.
- Effective transmission of accurate and timely information is critical for complex patient care.
- Studying the structure and processes of dynamic PICU teams is essential for improving patient outcomes.
Objective:
Complex and fluctuating care teams are a known obstacle to optimal patient care in the pediatric intensive care unit (PICU), particularly for long stay patients (LSP). Overcoming this obstacle requires understanding more about how PICU teams are structured and function. Our objective is to empirically define the dynamic composition of PICU care teams for LSP and non-LSP.
Patients And Methods:
We conducted a retrospective chart review of patients aged 0 to 21 years admitted to medical/surgical and cardiovascular PICUs of a Midwestern tertiary care academic children's hospital in March and September 2019. Patients were divided between PICU LOS of 7 days or fewer and LOS of more than 7 days. Patients who were admitted for cardiac surgery and those patients who had opted out of research were excluded. The main outcome of the study was the number and specialty composition of teams caring for long stay vs short stay patients.
Results:
A total of 35 patients were identified (51.4% female, median age 1.8 years); 20 patients were identified with LOS of greater than 7 days ("long stay") and 15 patients with LOS of 7 days or fewer ("short stay"). We present sociometric network models to visualize the complexity of team composition and structure over time.
Conclusions:
As illustrated by the complex web of physician interactions revolving around the patients, PICU teams are dynamic and members are ever changing, highlighting the importance of transmitting accurate, relevant and timely information when caring for complex patients. This work clearly demonstrates why it is vital to study both the structure and processes of these dynamic PICU teams.
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