Co-Evolutions of Pediatric and Adult Critical Care

Multidisciplinary Consensus on Curricular Priorities for Pediatric Neurocritical Care Nursing Education: A Modified Delphi Study in the United States

BACKGROUND

Nurses are vital partners in the development of pediatric neurocritical care (PNCC) programs. Nursing expertise is acknowledged to be an integral component of high-quality specialty patient care in the field, but little guidance exists regarding educational requirements to build that expertise. We sought to obtain expert consensus from nursing professionals and physicians on curricular priorities for specialized PNCC nursing education in pediatric centers across the United States.

METHODS

We used a modified Delphi study technique surveying a multidisciplinary expert panel of nursing professionals and physicians. Online surveys were distributed to 44 panelists over three rounds to achieve consensus on curricular topics deemed essential for PNCC nursing education. During each round, panelists were asked to rate topics as essential or not essential, as well as given opportunities to provide feedback and suggest changes. Feedback was shared anonymously to the panelist group throughout the process.

RESULTS

From 70 initial individual topics, the consensus process yielded 19 refined topics that were confirmed to be essential for a PNCC nursing curriculum by the expert panel. Discrepancies existed regarding how universally to recommend topics of advanced neuromonitoring, such as brain tissue oxygenation; specialized neurological assessments, such as the serial neurological assessment in pediatrics or National Institutes of Health Stroke Scale; and some disease-based populations. Panelists remarked that not all centers see specific diseases, and not all centers currently employ advanced neuromonitoring technologies and skills.

CONCLUSIONS

We report 19 widely accepted curricular priorities that can serve as a standard educational base for PNCC nursing. Developing education for nurses in PNCC will complement PNCC programs with targeted nursing expertise that extends comprehensive specialty care to the bedside. Further work is necessary to effectively execute educational certification programs, implement nursing standards in the field, and evaluate the impact of nursing expertise on patient care and outcomes.

National Survey of Combined Pediatrics-Anesthesiology Residents and Graduates: Factors Contributing to Changing Career Aspirations Over Time

BACKGROUND

The Dual Pathway for Certification in Pediatrics and Anesthesiology was created in 2011 to develop leaders in caring for children with complex medical and surgical conditions. While existing dual-trained practitioners report continued practice in both pediatric anesthesiology (PA) and pediatric critical care medicine (PCCM), recent surveys of dual pathway trainees have shown that only one-quarter still currently plan to pursue training in PCCM, a change from their initial plans to complete training in both PA and PCCM. The aim of this study was to further characterize the motivations driving shifts in career trajectory during training as well as factors affecting the combined training experience.

METHODS

We conducted an online mixed-methods survey of all individuals who had matriculated at 1 of the 7 Accreditation Council for Graduate Medical Education-accredited combined pediatrics-anesthesiology residencies from 2011 to 2018. The survey consisted of a 30-item questionnaire addressing training experience, anticipated career trajectory, and respondent demographics. Descriptive statistics were used for closed-format questions. Responses to open-ended questions were systematically analyzed through inductive iterative review by 2 of the authors to elicit a set of overarching themes.

RESULTS

We achieved a response rate of 85% (n = 53/62) with respondents from 7 of 7 combined residency programs. When asked about career goals, the majority of respondents planned to pursue both PA and PCCM (60%, n = 32) at the start of residency. However, at the time of survey completion, the percentage of respondents who were still planning to (or had already completed) train in both PA and PCCM had decreased to 23% (n = 12). Factors such as lifestyle and length of training contributed more to career choices during/after training compared to before residency. Thematic analysis of open-ended questions regarding transition between specialties, impact of dual training, and general comments revealed 3 major themes: (1) challenges of transitioning between specialties, (2) dual training is mutually beneficial, and (3) the need for an established fellowship training pathway.

CONCLUSIONS

While there is continued interest in dual training in PA/PCCM for residents who enter the combined pediatrics-anesthesiology residency, factors such as duration of training and lifestyle become more important during residency and alter their career trajectories, often away from PCCM. Optimization of dual-subspecialty fellowship training will be critical to sustaining interest in dual-subspecialty training in PA/PCCM.

[Etiology composition and prognosis of pediatric chronic critical illness in a pediatric intensive care unit]

OBJECTIVES

To explore the etiology composition and outcomes of pediatric chronic critical illness (PCCI) in the pediatric intensive care unit (PICU).

METHODS

The children who were hospitalized in the PICU of Dongguan Children's Hospital Affiliated to Guangdong Medical University and met the diagnostic criteria for PCCI from January 2017 to December 2022 were included in the study. The etiology of the children was classified based on their medical records and discharge diagnoses. Relevant clinical data during hospitalization were collected and analyzed.

RESULTS

Among the 3 955 hospitalized children in the PICU from January 2017 to December 2022, 321 cases (8.12%) met the diagnostic criteria for PCCI. Among the 321 cases, the most common etiology was infection (71.3%, 229 cases), followed by unintentional injury (12.8%, 41 cases), postoperation (5.9%, 19 cases), tumors/immune system diseases (5.0%, 16 cases), and genetic and chromosomal diseases (5.0%, 16 cases). Among the 321 cases, 249 cases (77.6%) were discharged after improvement, 37 cases (11.5%) were discharged at the request of the family, and 35 cases (10.9%) died in the hospital. Among the deaths, infection accounted for 74% (26/35), unintentional injury accounted for 17% (6/35), tumors/immune system diseases accounted for 6% (2/35), and genetic and chromosomal diseases accounted for 3% (1/35). From 2017 to 2022, the proportion of PCCI in PICU diseases showed an increasing trend year by year (P<0.05). Among the 321 children with PCCI, there were 148 infants and young children (46.1%), 57 preschool children (17.8%), 54 school-aged children (16.8%), and 62 adolescents (19.3%), with the highest proportion in the infant and young children group (P<0.05). The in-hospital mortality rates of the four age groups were 14.9% (22/148), 8.8% (5/57), 5.6% (3/54), and 8.1% (5/62), respectively. The infant and young children group had the highest mortality rate, but there was no statistically significant difference among the four groups (P>0.05).

CONCLUSIONS

The proportion of PCCI in PICU diseases is increasing, and the main causes are infection and unintentional injury. The most common cause of death in children with PCCI is infection. The PCCI patient population is mainly infants and young children, and the in-hospital mortality rate of infant and young children with PCCI is relatively high.

Net Promoter Score (NPS) as a tool to assess parental satisfaction in pediatric intensive care units

OBJECTIVE

To verify the performance of the Net Promoter Score (NPS) as a tool to assess parental satisfaction in pediatric intensive care units (PICUs).

METHODS

The authors conducted an observational cross-sectional multicenter study in the PICUs of 5 hospitals in Brazil. Eligible participants were all parents or legal guardians of PICU-admitted children, aged 18 years or over. The NPS was administered together with the EMpowerment of PArents in THe Intensive Care (EMPATHIC-30), used as the gold standard, and a sociodemographic questionnaire. For analysis, the results were dichotomized into values greater than or equal to the median of the tests. The associations between the 2 tools were evaluated and the distribution of their results was compared.

RESULTS

The parents or legal guardians of 78 PICU-admitted children were interviewed. Of the respondents, 85% were women and 62% were in a private hospital. The median NPS was 10 (IQR, 10-10), and the median EMPATHIC-30 score was 5.7 (IQR, 5.4-5.9). Compared with the gold standard, the NPS had a sensitivity of 100% at all cutoff points, except at cutoff 10, where the sensitivity was slightly lower (97.5%). As for specificity, NPS performance was poorer, with values ranging from 0% (NPS ≥ 5) to 47.4% (NPS = 10).

CONCLUSIONS

NPS proved to be a sensitive tool to assess parental satisfaction, but with poor ability to identify dissatisfied users in the sample.

Adhering to Social Distancing Rules Using a "Split Patient" Model With Rapid Cycle Deliberate Practice in Pediatric High-Fidelity Simulations

The coronavirus disease 2019 (COVID-19) pandemic has required simulation-based medical education to adapt to physical distancing regulations in order to protect learners and facilitators. The "split patient" model allows for physical distancing of learners in pediatric high-fidelity simulations. This model was able to be used with the Rapid Cycle Deliberate Practice to teach pediatric residents basic and advanced life support skills and the principles of Crisis Resource Management.