Long Stay Patients & Primary Intensivists with Dr. Jeff Edwards and Dr. Erin Gordon Part 1
Jun 26, 2023
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Dr. Jeff Edwards and Dr. Erin Gordon discuss long stay patients in the pediatric ICU, including challenges and impact, mental health consequences for families, developmental outcomes for children, and strategies for improving continuity of care.
Primary intensivist programs and primary nursing can improve continuity of care and patient outcomes for long-stay patients in the pediatric ICU.
Long-stay patients in the PICU face higher risks of morbidity, delayed development, and mental health challenges, which primary intensivist programs aim to address through continuity and targeted interventions.
Deep dives
Improving Care for Long-Stay Patients in the Pediatric ICU
Long-stay patients in the pediatric ICU (PICU) require special attention due to their high risk for adverse events and readmissions. Primary intensivists, primary nurses, and multidisciplinary team meetings are strategies that can improve continuity of care and patient outcomes. Primary intensivists provide consistent physician resource despite changes in attending physicians, while primary nurses offer greater accountability, autonomy, and teamwork. Multidisciplinary team meetings bring together specialists to discuss complex cases and create consensus on patient care. Studies show that primary intensivist and nursing programs can reduce length of stay and improve communication and decision-making, benefiting both patients and families. However, implementing these programs may require cultural change and addressing challenges such as stress and discordant goals.
Morbidity and Mental Health Considerations for Long-Stay Patients
Long-stay patients in the PICU are at a higher risk for morbidity, medical errors, and hospital-acquired infections. These patients and their families also face mental health challenges, including increased rates of anxiety, depression, and post-traumatic stress disorder. Prolonged ICU stays can delay a child's development and affect their educational outcomes. Primary intensivist programs aim to address these challenges by promoting informational and management continuity. By involving primary nurses and holding multidisciplinary meetings, targeted interventions can provide better resource availability, advocate for families, and improve mental health outcomes for both patients and families.
Evidence for Primary Intensivist Programs
Studies suggest that primary intensivist programs in the PICU have had positive effects on patient care. They have shown improved understanding of patient problems, better relationships with families, and enhanced team communication. Primary intensivist and nursing programs may lead to a reduction in length of stay and fewer unplanned re-intubations. Parents of children who receive primary intensivist care report better communication, listening, and decision-making. However, there are challenges associated with these programs, including increased stress for primary intensivists and the need to manage discordant goals between primary intensivists and service teams. Further research is needed to better understand the impact and cost-effectiveness of primary intensivist models.
Jeffrey Edwards, M.D is an Associate Professor of Pediatrics at Columbia University and a pediatric intensivist at Morgan Stanley Children’s Hospital in New York. He is an active physician-investigator with clinical and research interests in children with complex chronic conditions and technology-dependence.
Erin Gordon, D.O. is an Assistant Professor of Pediatrics at University of Texas Southwestern and an intensivist in the pediatric cardiac intensive care unit. Dr. Gordon is the medical director of the inpatient developmental care program and directly involved in creating an environment that fosters the growth and development of the congenital heart disease population, including parental mental health and resilience. Her passion for patient and family advocacy has led to her desire to bring a louder voice to the concept of a “primary” intensivist.
Learning objectives:
After listening to this series of episodes, learners should be able to discuss:
The discrepant health-related outcomes of long-stay patients (LSP) and those with complex chronic conditions (CCC) in the PICU.
Barriers to delivering effective care to LSPs and those with CCC in the PICU.
Strategies to improve continuity of care to LSPs and to those with CCC in the PICU.
The rationale and evidence supporting the use of a primary intensivist program in the PICU.
Patient eligibility criteria and best practices of a primary intensivist program with an emphasis on equity and minimizing the risk of bias.
Physician specific and healthcare system related strategies to maintaining a successful primary intensivist program.
The role of a PICU fellow in providing care similar to a primary intensivist.
Next steps in implementation and research of primary intensivists in PICUs.
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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
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