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Smith MB, Dervan LA, Watson RS, Ohman RT, Albert JEM, Rhee EJ, Vavilala MS, Rivara FP, Killien EY. Family Presence at the PICU Bedside: A Single-Center Retrospective Cohort Study. Pediatr Crit Care Med 2023; 24:1053-1062. [PMID: 38055001 DOI: 10.1097/pcc.0000000000003334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVES To determine factors associated with bedside family presence in the PICU and to understand how individual factors interact as barriers to family presence. DESIGN Mixed methods study. SETTING Tertiary children's hospital PICU. SUBJECTS Five hundred twenty-three children of less than 18 years enrolled in the Seattle Children's Hospital Outcomes Assessment Program from 2011 to 2017. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Quantitative: Family was documented every 2 hours. Exposures included patient and illness characteristics and family demographic and socioeconomic characteristics. We used multivariable logistic regression to identify factors associated with presence of less than 80% and stratified results by self-reported race. Longer PICU length of stay (LOS), public insurance, and complex chronic conditions (C-CD) were associated with family presence of less than 80%. Self-reported race modified these associations; no factors were associated with lower bedside presence for White families, in contrast with multiple associations for non-White families including public insurance, C-CD, and longer LOS. Qualitative: Thematic analysis of social work notes for the 48 patients with family presence of less than 80% matched on age, LOS, and diagnosis to 48 patients with greater than or equal to 95% family presence. Three themes emerged: the primary caregiver's prior experiences with the hospital, relationships outside of the hospital, and additional stressors during the hospitalization affected bedside presence. CONCLUSIONS We identified sociodemographic and illness factors associated with family bedside presence in the PICU. Self-reported race modified these associations, representing racism within healthcare. Family presence at the bedside may help identify families facing greater disparities in healthcare access.
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Affiliation(s)
- Mallory B Smith
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Leslie A Dervan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
| | - R Scott Watson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA
| | - Robert T Ohman
- Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, WA
| | - J Elaine-Marie Albert
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
| | - Eileen J Rhee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington, Seattle, WA
| | - Monica S Vavilala
- Department of Anesthesiology, University of Washington, Seattle, WA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
| | - Frederick P Rivara
- Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, WA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
| | - Elizabeth Y Killien
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
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