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Chang N, Louderback L, Hammett H, Hildebrandt K, Prendergast E, Sperber A, Casazza M, Landess M, Little A, Rasmussen L. Multidisciplinary Consensus on Curricular Priorities for Pediatric Neurocritical Care Nursing Education: A Modified Delphi Study in the United States. Neurocrit Care 2024; 41:568-575. [PMID: 38570410 DOI: 10.1007/s12028-024-01976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
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.
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Affiliation(s)
- Nathan Chang
- Pediatric Neurocritical Care, Lucile Packard Children's Hospital Stanford, 725 Welch Rd., Palo Alto, CA, 94404, USA.
| | - Lauren Louderback
- Pediatric Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Heather Hammett
- Pediatric Critical Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Kara Hildebrandt
- Pediatric Neurocritical Care, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Erica Prendergast
- Pediatric Neurocritical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Amelia Sperber
- Pediatric Neurocritical Care, Lucile Packard Children's Hospital Stanford, 725 Welch Rd., Palo Alto, CA, 94404, USA
| | - May Casazza
- Pediatric Neurocritical Care, Lucile Packard Children's Hospital Stanford, 725 Welch Rd., Palo Alto, CA, 94404, USA
| | - Megan Landess
- Pediatric Critical Care, Children's Hospital Colorado, Aurora, CO, USA
| | - Aubree Little
- Pediatric Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lindsey Rasmussen
- Pediatric Neurocritical Care, Lucile Packard Children's Hospital Stanford, 725 Welch Rd., Palo Alto, CA, 94404, USA
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Hong SJ, Wainwright MS, Abend NS, Appavu BL, Francoeur C, Erklauer JC, Guerguerian AM, Guerriero RM, Guilliams KP, Lee-Eng J, Loeb J, Lovett ME, Murphy SA, Pardo AC, Pineda JA, Ruzas CM, Topjian AA. A Survey of Pediatric Neurocritical Care Fellowship Training in North America. Pediatr Neurol 2023; 146:1-7. [PMID: 37356227 DOI: 10.1016/j.pediatrneurol.2023.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/22/2023] [Accepted: 05/24/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Pediatric neurocritical care (PNCC) has emerged as a field to care for children at the intersection of critical illness and neurological dysfunction. PNCC fellowship programs evolved over the past decade to train physicians to fill this clinical need. We aimed to characterize PNCC fellowship training infrastructure and curriculum in the United States and Canada. METHODS Web-based survey of PNCC fellowship program leaders during November 2019 to January 2020. RESULTS There were 14 self-identified PNCC fellowship programs. The programs were supported by Child Neurology and/or Pediatric Critical Care Medicine divisions at tertiary/quaternary care institutions. Most programs accepted trainees who were board-eligible or board-certified in child neurology or pediatric critical care medicine. Clinical training consisted mostly of rotations providing PNCC consultation (n = 13) or as a provider on the pediatric intensive care unit-based neurointensive care team (n = 2). PNCC-specific didactics were delivered at most institutions (n = 13). All institutions provided training in electroencephalography use in the intensive care unit and declaration of death by neurological criteria (n = 14). Scholarly activity was supported by most programs, including protected time for research (n = 10). CONCLUSIONS We characterized PNCC fellowship training in the United States and Canada, which in this continuously evolving field, lays the foundation for exploring standardization of training going forward.
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Affiliation(s)
- Sue J Hong
- Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Mark S Wainwright
- University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Nicholas S Abend
- University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Brian L Appavu
- University of Arizona College of Medicine - Phoenix, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, Arizona
| | - Conall Francoeur
- CHU de Québec - Université Laval Research Center, Quebec, Canada
| | | | | | - Réjean M Guerriero
- Washington University School of Medicine in St. Louis, St. Louis Children's Hospital, St. Louis, Missouri
| | - Kristin P Guilliams
- Washington University School of Medicine in St. Louis, St. Louis Children's Hospital, St. Louis, Missouri
| | | | - Joshua Loeb
- Loma Linda University Children's Hospital, Loma Linda, California
| | - Marlina E Lovett
- Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Sarah A Murphy
- Harvard Medical School, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Andrea C Pardo
- Northwestern University Feinberg School of Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jose A Pineda
- USC Keck School of Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Christopher M Ruzas
- University of Colorado School of Medicine, Children's Hospital of Colorado, Aurora, Colorado
| | - Alexis A Topjian
- University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Benedetti GM, Morgan LA, Sansevere AJ, Harrar DB, Guerriero RM, Wainwright MS, LaRovere KL, Kielian A, Ganesan SL, Press CA. The Spectrum of Quantitative EEG Utilization Across North America: A Cross-Sectional Survey. Pediatr Neurol 2023; 141:1-8. [PMID: 36731228 DOI: 10.1016/j.pediatrneurol.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/16/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Continuous electroencephalography (cEEG) is commonly used for neuromonitoring in pediatric intensive care units (PICU); however, there are barriers to real-time interpretation of EEG data. Quantitative EEG (qEEG) transforms the EEG signal into time-compressed graphs, which can be displayed at the bedside. A survey was designed to understand current PICU qEEG use. METHODS An electronic survey was sent to the Pediatric Neurocritical Care Research Group and Pediatric Status Epilepticus Research Group, and intensivists in 16 Canadian PICUs. Questions addressed demographics, qEEG acquisition and storage, clinical use, and education. RESULTS Fifty respondents from 39 institutions completed the survey (response rate 53% [39 of 74 institutions]), 76% (37 of 50) from the United States and 24% (12 of 50) from Canada. Over half of the institutions (22 of 39 [56%]) utilize qEEG in their ICUs. qEEG use was associated with having a neurocritical care (NCC) service, ≥200 NCC consults/year, ≥1500 ICU admissions/year, and ≥4 ICU EEGs/day (P < 0.05 for all). Nearly all users (92% [24 of 26]) endorsed that qEEG enhanced care of children with acute neurological injury. Lack of training in qEEG was identified as a common barrier [85% (22 of 26)]. Reviewing and reporting of qEEG was not standard at most institutions. Training was required by 14% (three of 22) of institutions, and 32% (seven of 22) had established curricula. CONCLUSIONS ICU qEEG was used at more than half of the institutions surveyed, but review, reporting, and application of this tool remained highly variable. Although providers identify qEEG as a useful tool in patient management, further studies are needed to define clinically meaningful pediatric trends, standardize reporting, and enhance educate bedside providers.
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Affiliation(s)
- Giulia M Benedetti
- Division of Pediatric Neurology, Department of Neurology, University of Washington School of Medicine, Seattle, Washington
| | - Lindsey A Morgan
- Division of Pediatric Neurology, Department of Neurology, University of Washington School of Medicine, Seattle, Washington
| | - Arnold J Sansevere
- Department of Neurology, Children's National Hospital and Departments of Neurology and Pediatrics, George Washington University School of Medicine, Washington, District of Columbia
| | - Dana B Harrar
- Department of Neurology, Children's National Hospital and Departments of Neurology and Pediatrics, George Washington University School of Medicine, Washington, District of Columbia
| | - Réjean M Guerriero
- Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Mark S Wainwright
- Division of Pediatric Neurology, Department of Neurology, University of Washington School of Medicine, Seattle, Washington
| | - Kerri L LaRovere
- Department of Neurology, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Agnieszka Kielian
- Department of Neurology, Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Saptharishi Lalgudi Ganesan
- Paediatric Critical Care Medicine, Children's Hospital of Western Ontario, London Health Sciences Centre, London, Ontario, Canada; Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Craig A Press
- Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Nash KB, Palaganas J, Abend NS, Hutchinson ML, Messer R, Moharir M, Piantino J, Press CA, Wells E. The State of Inpatient Child Neurology: A Survey of North American Academic Programs. Neurology 2022; 99:e2025-e2033. [PMID: 36096689 DOI: 10.1212/wnl.0000000000201101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Inpatient child neurology programs provide essential services for children. We sought to understand the current structure and challenges of inpatient pediatric neurologic care delivery in academic programs in North America. METHODS We identified a single child neurologist from 39 of the first 40 programs on the 2019-2020 US News and World Report ranking and 3 large Canadian programs to be invited to participate in an inpatient focused survey. In October 2020, these 42 child neurologists were invited to complete an anonymous on-line survey including 37 questions about the structure, workload, and challenges of their inpatient program. Data were analyzed descriptively. RESULTS We received responses from 30/42 (71%) invited child neurologists from unique programs. Most (22/30, 73%) were Child Neurology Program Directors, Inpatient Directors, and/or Division Chiefs. Two-thirds (20/30, 67%) reported a total of 2-4 inpatient services. Two-thirds (20/30, 67%) reported a primary neurology admitting service. Nearly two-thirds (19/30, 63%) reported a separate intensive care unit service, and approximately one-third (11/30, 37%) reported a separate stroke/vascular service. Half of the respondents (15/30, 50%) reported some attendings whose primary clinical effort is in the inpatient setting. Over half (17/30, 57%) reported having trainees interested in inpatient-focused careers. Approximately half (16/30, 53%) reported a full-time equivalent metric for inpatient time, and under half (13/30, 43%) reported the use of critical-care billing. Most respondents (26/30, 87%) endorsed that inpatient attendings frequently complete documentation/sign notes outside of normal daytime hours. During night call, attendings commonly spend 30 minutes-2 hours on patient care-related phone calls between 5 and 10 pm (24/30, 80%) and receive 1-3 patient care-related phone calls after 10 pm (21/30, 70%). Faculty burnout was the biggest inpatient-specific challenge before the coronavirus disease 2019 (COVID-19) pandemic (25/30, 83%), and concern about faculty well-being during the COVID-19 pandemic was reported in nearly all respondents (28/30, 93%). DISCUSSION Academic child neurology programs in North America implement varied models for inpatient care delivery and face common challenges. The information presented in this study serves to stimulate discussion, help optimize operations, and encourage novel approaches to accomplish work and advance careers in academic inpatient child neurology.
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Affiliation(s)
- Kendall B Nash
- From the Departments of Neurology and Pediatrics (K.B.N.), University of California, San Francisco, Benioff Children's Hospital San Francisco; Department of Pediatrics (J. Palaganas), Weill Cornell Medicine, New York Presbyterian Hospital; Departments of Neurology and Pediatrics (N.S.A., C.A.P.), Children's Hospital of Philadelphia and the University of Pennsylvania; Neurology Division (M.L.H.), Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus; Section of Child Neurology (R.M.), Department of Pediatrics, Children's Hospital Colorado and the University of Colorado, Aurora; Division of Neurology (M.M.), Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada; Section of Child Neurology (J. Piantino), Department of Pediatrics, Oregon Health & Science University, Portland; and Center for Neuroscience (E.W.), Children's National Hospital and the George Washington University School of Medicine and Health Science, Washington, D.C.
| | - Jamie Palaganas
- From the Departments of Neurology and Pediatrics (K.B.N.), University of California, San Francisco, Benioff Children's Hospital San Francisco; Department of Pediatrics (J. Palaganas), Weill Cornell Medicine, New York Presbyterian Hospital; Departments of Neurology and Pediatrics (N.S.A., C.A.P.), Children's Hospital of Philadelphia and the University of Pennsylvania; Neurology Division (M.L.H.), Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus; Section of Child Neurology (R.M.), Department of Pediatrics, Children's Hospital Colorado and the University of Colorado, Aurora; Division of Neurology (M.M.), Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada; Section of Child Neurology (J. Piantino), Department of Pediatrics, Oregon Health & Science University, Portland; and Center for Neuroscience (E.W.), Children's National Hospital and the George Washington University School of Medicine and Health Science, Washington, D.C
| | - Nicholas S Abend
- From the Departments of Neurology and Pediatrics (K.B.N.), University of California, San Francisco, Benioff Children's Hospital San Francisco; Department of Pediatrics (J. Palaganas), Weill Cornell Medicine, New York Presbyterian Hospital; Departments of Neurology and Pediatrics (N.S.A., C.A.P.), Children's Hospital of Philadelphia and the University of Pennsylvania; Neurology Division (M.L.H.), Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus; Section of Child Neurology (R.M.), Department of Pediatrics, Children's Hospital Colorado and the University of Colorado, Aurora; Division of Neurology (M.M.), Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada; Section of Child Neurology (J. Piantino), Department of Pediatrics, Oregon Health & Science University, Portland; and Center for Neuroscience (E.W.), Children's National Hospital and the George Washington University School of Medicine and Health Science, Washington, D.C
| | - Melissa L Hutchinson
- From the Departments of Neurology and Pediatrics (K.B.N.), University of California, San Francisco, Benioff Children's Hospital San Francisco; Department of Pediatrics (J. Palaganas), Weill Cornell Medicine, New York Presbyterian Hospital; Departments of Neurology and Pediatrics (N.S.A., C.A.P.), Children's Hospital of Philadelphia and the University of Pennsylvania; Neurology Division (M.L.H.), Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus; Section of Child Neurology (R.M.), Department of Pediatrics, Children's Hospital Colorado and the University of Colorado, Aurora; Division of Neurology (M.M.), Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada; Section of Child Neurology (J. Piantino), Department of Pediatrics, Oregon Health & Science University, Portland; and Center for Neuroscience (E.W.), Children's National Hospital and the George Washington University School of Medicine and Health Science, Washington, D.C
| | - Ricka Messer
- From the Departments of Neurology and Pediatrics (K.B.N.), University of California, San Francisco, Benioff Children's Hospital San Francisco; Department of Pediatrics (J. Palaganas), Weill Cornell Medicine, New York Presbyterian Hospital; Departments of Neurology and Pediatrics (N.S.A., C.A.P.), Children's Hospital of Philadelphia and the University of Pennsylvania; Neurology Division (M.L.H.), Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus; Section of Child Neurology (R.M.), Department of Pediatrics, Children's Hospital Colorado and the University of Colorado, Aurora; Division of Neurology (M.M.), Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada; Section of Child Neurology (J. Piantino), Department of Pediatrics, Oregon Health & Science University, Portland; and Center for Neuroscience (E.W.), Children's National Hospital and the George Washington University School of Medicine and Health Science, Washington, D.C
| | - Mahendranath Moharir
- From the Departments of Neurology and Pediatrics (K.B.N.), University of California, San Francisco, Benioff Children's Hospital San Francisco; Department of Pediatrics (J. Palaganas), Weill Cornell Medicine, New York Presbyterian Hospital; Departments of Neurology and Pediatrics (N.S.A., C.A.P.), Children's Hospital of Philadelphia and the University of Pennsylvania; Neurology Division (M.L.H.), Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus; Section of Child Neurology (R.M.), Department of Pediatrics, Children's Hospital Colorado and the University of Colorado, Aurora; Division of Neurology (M.M.), Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada; Section of Child Neurology (J. Piantino), Department of Pediatrics, Oregon Health & Science University, Portland; and Center for Neuroscience (E.W.), Children's National Hospital and the George Washington University School of Medicine and Health Science, Washington, D.C
| | - Juan Piantino
- From the Departments of Neurology and Pediatrics (K.B.N.), University of California, San Francisco, Benioff Children's Hospital San Francisco; Department of Pediatrics (J. Palaganas), Weill Cornell Medicine, New York Presbyterian Hospital; Departments of Neurology and Pediatrics (N.S.A., C.A.P.), Children's Hospital of Philadelphia and the University of Pennsylvania; Neurology Division (M.L.H.), Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus; Section of Child Neurology (R.M.), Department of Pediatrics, Children's Hospital Colorado and the University of Colorado, Aurora; Division of Neurology (M.M.), Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada; Section of Child Neurology (J. Piantino), Department of Pediatrics, Oregon Health & Science University, Portland; and Center for Neuroscience (E.W.), Children's National Hospital and the George Washington University School of Medicine and Health Science, Washington, D.C
| | - Craig A Press
- From the Departments of Neurology and Pediatrics (K.B.N.), University of California, San Francisco, Benioff Children's Hospital San Francisco; Department of Pediatrics (J. Palaganas), Weill Cornell Medicine, New York Presbyterian Hospital; Departments of Neurology and Pediatrics (N.S.A., C.A.P.), Children's Hospital of Philadelphia and the University of Pennsylvania; Neurology Division (M.L.H.), Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus; Section of Child Neurology (R.M.), Department of Pediatrics, Children's Hospital Colorado and the University of Colorado, Aurora; Division of Neurology (M.M.), Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada; Section of Child Neurology (J. Piantino), Department of Pediatrics, Oregon Health & Science University, Portland; and Center for Neuroscience (E.W.), Children's National Hospital and the George Washington University School of Medicine and Health Science, Washington, D.C
| | - Elizabeth Wells
- From the Departments of Neurology and Pediatrics (K.B.N.), University of California, San Francisco, Benioff Children's Hospital San Francisco; Department of Pediatrics (J. Palaganas), Weill Cornell Medicine, New York Presbyterian Hospital; Departments of Neurology and Pediatrics (N.S.A., C.A.P.), Children's Hospital of Philadelphia and the University of Pennsylvania; Neurology Division (M.L.H.), Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus; Section of Child Neurology (R.M.), Department of Pediatrics, Children's Hospital Colorado and the University of Colorado, Aurora; Division of Neurology (M.M.), Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada; Section of Child Neurology (J. Piantino), Department of Pediatrics, Oregon Health & Science University, Portland; and Center for Neuroscience (E.W.), Children's National Hospital and the George Washington University School of Medicine and Health Science, Washington, D.C
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