The factors associated with high-quality communication for critically ill children.

نویسندگان

  • Jennifer K Walter
  • Brian D Benneyworth
  • Michelle Housey
  • Matthew M Davis
چکیده

OBJECTIVE Timely, high quality communication with families is essential to family-centered decision-making. Quality communication is represented by widespread documentation of prognostic, goals-of-care conversations (PGOCC) in the pediatric intensive care unit (PICU) and should occur without variation by patient characteristics. METHODS Cohort included 645 PICU admissions in the top decile of risk of mortality on admission over six years. Electronic medical records were used to determine PGOCC, diagnosis on admission and complex chronic condition (CCC) status. Multivariate logistic regression and time-to-event analyses were used. RESULTS Overall, 31% had a documented PGOCC. 51% had CCC status. 11% had an oncologic, 13% had a cardiovascular diagnosis on admission. 94% of patients who died in the PICU had PGOCC documented, but among the 200 patients with documented PGOCC, 78% did not die in the PICU. Oncologic diagnosis on admission was associated with a higher likelihood of PGOCC compared to non-CCC patients (ARR=1.86; SE=0.26) whereas no other diagnosis category reached the level of statistical significance. Median time from admission to PGOCC was 2 days. Age, gender and CCC status were not associated with whether a PGOCC was documented or with time from admission to PGOCC documentation. 45% of PGOCC in the cohort and 50% of conversations in patients with CCC were documented by PICU physicians. CONCLUSIONS This study reveals the opportunity for improvement in documentation of PGOCC for critically ill children. It raises the questions of why there is variation of PGOCC across disease categories and whether PGOCC should be considered a quality measure for family-centered care.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Description of the Clinical Course and Severity Score Progression in Critically Ill Children with Acute Bronchiolitis on High-Flow Nasal Cannula Support

Background and Objective: Bronchiolitis is one of the main causes of morbidity and mortality in children. High-flow nasal cannulas (HFNCs) are an alternative for managing moderate to severe cases. Our aim was to describe the outcomes in critically ill children with bronchiolitis who receive HFNC support. Materials and Methods: This was a retrospective cohort study of critically ill children wh...

متن کامل

Using Iron-Chelating Agents in Critically Ill Patients with Iron Overload. Fact or Fiction?

Recently, some evidence has shown that the failure of iron homeostasis may occur in critically ill patients and can lead to iron overload. Elevated ferritin levels as a body iron burden index in critically ill patients may be associated with depressed level of consciousness and greater mortality. However, the necessity of using iron-chelating agents in clinical situation is still unknown for th...

متن کامل

Islam-Based Caring for the Harmony of Life among Moslem Critically Ill Patients

Background: The application of more humanized approaches in the caring process of the Intensive Care Unit (ICU) patients with the aim of improving the quality of care has been given a growing attention However, there are limited studies regarding the Islam-based caring for the Moslem populations in Indonesia. Aim: This study aimed to explore and describe the caring actions employed by nurses to...

متن کامل

Pharmacokinetic Behavior of Theophylline following PEEP in Critically Ill Patients with Acute Lung Injury

The effect of Positive End Expiratory Pressure (PEEP) on the hepatic elimination of low to moderate extraction ratio drugs has not been clearly defined. We prospectively investigated the effect of PEEP on the clearance of theophylline in 30 (20 males and 10 females) intubated critically ill adult patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). The Mean (±SD) age ...

متن کامل

Pharmacokinetic Behavior of Theophylline following PEEP in Critically Ill Patients with Acute Lung Injury

The effect of Positive End Expiratory Pressure (PEEP) on the hepatic elimination of low to moderate extraction ratio drugs has not been clearly defined. We prospectively investigated the effect of PEEP on the clearance of theophylline in 30 (20 males and 10 females) intubated critically ill adult patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). The Mean (±SD) age ...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • Pediatrics

دوره 131 Suppl 1  شماره 

صفحات  -

تاریخ انتشار 2013