TY - JOUR
T1 - Continuity Strategies for Long-Stay PICU Patients
T2 - Consensus Statements From the Lucile Packard Foundation PICU Continuity Panel
AU - Edwards, Jeffrey D.
AU - Wocial, Lucia D.
AU - Madrigal, Vanessa N.
AU - Moon, Michelle M.
AU - Ramey-Hunt, Cheryl
AU - Walter, Jennifer K.
AU - Baird, Jennifer D.
AU - Leland, Brian D.
AU - Akers, Jennifer
AU - Carlson, Sarah
AU - Carnevale, Franco
AU - Chaillou, Anne Laure
AU - Check, Jennifer
AU - Crowley, Heather
AU - Dewitt, Aaron
AU - Garcia, Xiomara
AU - Goodman, Denise
AU - Graf, Jeanine
AU - Graham, Robert
AU - Grossoehme, Daniel
AU - Hagen, Scott
AU - Hannan, Ann
AU - Harris, Debbi
AU - Haut, Catherine
AU - Hayes, Tara
AU - Hicks, Shawnda
AU - Johnson, Michael
AU - Lee, K. Jane
AU - Parlow, Becky
AU - Roberts, Lynn
AU - Sanders, Marilyn
AU - Schindler, Christine
AU - Schwartz, Dawn
AU - Steffen, Katherine
N1 - Publisher Copyright:
© 2023 Lippincott Williams and Wilkins. All rights reserved.
PY - 2023/10/1
Y1 - 2023/10/1
N2 - OBJECTIVES: To develop consensus statements on continuity strategies using primary intensivists, primary nurses, and recurring multidisciplinary team meetings for long-stay patients (LSPs) in PICUs. PARTICIPANTS: The multidisciplinary Lucile Packard Foundation PICU Continuity Panel comprising parents of children who had prolonged PICU stays and experts in several specialties/professions that care for children with medical complexity in and out of PICUs. DESIGN/METHODS: We used modified RAND Delphi methodology, with a comprehensive literature review, Delphi surveys, and a conference, to reach consensus. The literature review resulted in a synthesized bibliography, which was provided to panelists. We used an iterative process to generate draft statements following panelists' completion of four online surveys with open-ended questions on implementing and sustaining continuity strategies. Panelists were anonymous when they voted on revised draft statements. Agreement of 80% constituted consensus. At a 3-day virtual conference, we discussed, revised, and re-voted on statements not reaching or barely reaching consensus. We used Grading of Recommendations Assessment, Development, and Evaluation to assess the quality of the evidence and rate the statements' strength. The Panel also generated outcome, process, and balancing metrics to evaluate continuity strategies. RESULTS: The Panel endorsed 17 consensus statements in five focus areas of continuity strategies (Eligibility Criteria, Initiation, Standard Responsibilities, Resources Needed to Implement, Resources Needed to Sustain). The quality of evidence of the statements was low to very low, highlighting the limited evidence and the importance of panelists' experiences/expertise. The strength of the statements was conditional. An extensive list of potential evaluation metrics was generated. CONCLUSIONS: These expert/parent-developed consensus statements provide PICUs with novel summaries on how to operationalize, implement, and sustain continuity strategies for LSP, a rapidly growing, vulnerable, resource-intensive population in PICUs.
AB - OBJECTIVES: To develop consensus statements on continuity strategies using primary intensivists, primary nurses, and recurring multidisciplinary team meetings for long-stay patients (LSPs) in PICUs. PARTICIPANTS: The multidisciplinary Lucile Packard Foundation PICU Continuity Panel comprising parents of children who had prolonged PICU stays and experts in several specialties/professions that care for children with medical complexity in and out of PICUs. DESIGN/METHODS: We used modified RAND Delphi methodology, with a comprehensive literature review, Delphi surveys, and a conference, to reach consensus. The literature review resulted in a synthesized bibliography, which was provided to panelists. We used an iterative process to generate draft statements following panelists' completion of four online surveys with open-ended questions on implementing and sustaining continuity strategies. Panelists were anonymous when they voted on revised draft statements. Agreement of 80% constituted consensus. At a 3-day virtual conference, we discussed, revised, and re-voted on statements not reaching or barely reaching consensus. We used Grading of Recommendations Assessment, Development, and Evaluation to assess the quality of the evidence and rate the statements' strength. The Panel also generated outcome, process, and balancing metrics to evaluate continuity strategies. RESULTS: The Panel endorsed 17 consensus statements in five focus areas of continuity strategies (Eligibility Criteria, Initiation, Standard Responsibilities, Resources Needed to Implement, Resources Needed to Sustain). The quality of evidence of the statements was low to very low, highlighting the limited evidence and the importance of panelists' experiences/expertise. The strength of the statements was conditional. An extensive list of potential evaluation metrics was generated. CONCLUSIONS: These expert/parent-developed consensus statements provide PICUs with novel summaries on how to operationalize, implement, and sustain continuity strategies for LSP, a rapidly growing, vulnerable, resource-intensive population in PICUs.
KW - child
KW - continuity of care
KW - intensive care units
KW - long-term care
KW - models
KW - nursing
KW - physician's
KW - practice patterns
UR - https://www.scopus.com/pages/publications/85174739724
U2 - 10.1097/PCC.0000000000003308
DO - 10.1097/PCC.0000000000003308
M3 - Article
AN - SCOPUS:85174739724
SN - 1529-7535
VL - 24
SP - 849
EP - 861
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 10
ER -