Children's National Health System, Washington, DC, United States.
Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Contemp Clin Trials. 2019 Jan;76:72-78. doi: 10.1016/j.cct.2018.11.011. Epub 2018 Nov 20.
Long-stay critically ill patients in the Pediatric Intensive Care Unit (PICU) may be at risk for inconsistencies in treatment plan, delay in plan progression, and patient/family dissatisfaction with communication. This article describes the development and evaluation of an intervention designed to improve continuity and communication delivered by continuity PICU attendings.
A randomized controlled trial of an intervention in one PICU that was randomized at the patient level. Eligible patients and their parents included those admitted to the PICU for longer than one week and were anticipated to remain for an additional 7 days. The intervention, a Continuity Care Intensivist (CCI), included early assignment of a continuity attending (separate from a regularly scheduled service attending), standardization of the continuity role to ensure consistent team and family contact and facilitate timely decision making, and enhancement of CCI communication skills. The outcomes evaluated were 1) patient PICU length of stay, ventilator-dependent days, and hospital acquired infections, 2) parental mood and satisfaction with PICU communication, and 3) intensivist perception of acceptability of intervention. Intention to treat analysis will be completed using multivariable linear regression to determine the impact of the intervention on outcomes. Lessons have been learned about the appropriate enrollment criteria for patients to allow for impact of continuity attending, frequent prognostic uncertainty in determining which patients will become longer stay in the PICU, and the difficulty of achieving timely initial contact of continuity attending with patients given the CCI's other commitments.
在儿科重症监护病房（PICU）中，长期住院的危重症患者可能面临治疗计划不一致、计划进展延迟以及患者/家属对沟通不满意的风险。本文介绍了一种旨在提高连续性主治医生提供的连续性和沟通的干预措施的开发和评估。
对一个 PICU 中的干预措施进行随机对照试验，该试验在患者水平上进行随机化。符合条件的患者及其父母包括那些在 PICU 中住院超过一周且预计还将再住院 7 天的患者。该干预措施是一名连续性主治医生（CCI），包括早期分配连续性主治医生（与常规服务主治医生分开）、标准化连续性角色以确保团队和家庭的持续接触并促进及时决策，以及增强 CCI 的沟通技巧。评估的结果包括 1）患者 PICU 住院时间、呼吸机依赖天数和医院获得性感染，2）父母的情绪和对 PICU 沟通的满意度，以及 3）主治医生对干预措施可接受性的看法。将使用多变量线性回归完成意向治疗分析，以确定干预对结果的影响。我们已经吸取了一些经验教训，包括患者的适当纳入标准，以允许连续性主治医生的影响，在确定哪些患者将成为 PICU 中更长时间住院的患者时经常出现预后不确定性，以及由于 CCI 的其他承诺，实现连续性主治医生与患者的及时初次接触的困难。
