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

TitleThe factors associated with high-quality communication for critically ill children.
Publication TypeJournal Article
Year of Publication2013
AuthorsWalter JK, Benneyworth BD, Housey M, Davis MM
JournalPediatrics
Volume131 Suppl 1
PaginationS90-5
Date Published2013 Mar
ISSN1098-4275
KeywordsAdolescent, Age Factors, Cardiovascular Diseases, Child, Child, Preschool, Cohort Studies, Communication, Critical Illness, Documentation, Female, Hospital Mortality, Humans, Infant, Infant, Newborn, Intensive Care Units, Pediatric, Male, Michigan, Multivariate Analysis, Neoplasms, Patient Care Planning, Professional-Family Relations, Prognosis, Retrospective Studies, Time Factors, Young Adult
Abstract

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.

DOI10.1542/peds.2012-1427k
Alternate JournalPediatrics
PubMed ID23457155
PubMed Central IDPMC4258825
Grant ListT32 HD07534 / HD / NICHD NIH HHS / United States