Evidence of Integrated Care for Critically Ill Children Through a Linguistic Examination of Progress Notes

A child's critical care hospitalization is stressful for families, immersing them in a highly technical and unfamiliar environment in which they encounter multiple healthcare providers. Medical decisions regarding the child's care must frequently be made, sometimes on relatively short notice. Providers in the pediatric critical care unit (PICU) have primary responsibility to care for the child and communicate with the family. Palliative care (PC) providers may be consulted for their expertise in the holistic care of the child and family and to elicit the family's goals of care for the child. This study's purpose was to characterize the linguistic properties of PICU and PC providers' progress notes and improve goal-concordant care by conducting a secondary analysis of their daily notes during a child's terminal critical care admission in a 467-bed quaternary pediatric hospital system in the midwestern United States. Notes were partitioned into PICU and PC notes, and their linguistic characteristics were quantified using Linguistic Inquiry and Word Count software, which returns the percentage of words in a text for over 90 parameters. Differences were analyzed using the Wilcoxon signed‑rank test. We present key differences between documented wording by PICU and PC providers, including linguistic convergence in most domains over the course of a child's terminal critical care admission. We also note that such convergence must be reestablished with each admission. We attribute linguistic differences to distinctive roles and expertise.