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Peterson R, Bruti C, Doraiswamy V, Hall AM. Improving the adult hospital experience: Reducing trauma with pediatric pearls. J Hosp Med 2024; 19:421-423. [PMID: 37661588 DOI: 10.1002/jhm.13196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Rachel Peterson
- Departments of Internal Medicine and Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christopher Bruti
- Departments of Internal Medicine and Pediatrics, Rush Medical College, Chicago, Illinois, USA
| | - Vignesh Doraiswamy
- Department of Internal Medicine and Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Alan M Hall
- Departments of Internal Medicine and Pediatrics, University of Kentucky College of Medicine in Lexington, Lexington, Kentucky, USA
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Opel DJ, Vo HH, Dundas N, Spielvogle H, Mercer A, Wilfond BS, Clark J, Heike CL, Weiss EM, Bryan MA, Shah SK, McCarty CA, Robinson JD, Blumenthal-Barby J, Tilburt J. Validation of a Process for Shared Decision-Making in Pediatrics. Acad Pediatr 2023; 23:1588-1597. [PMID: 36682451 DOI: 10.1016/j.acap.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We sought to confirm, refute, or modify a 4-step process for implementing shared decision-making (SDM) in pediatrics that involves determining 1) if the decision includes >1 medically reasonable option; 2) if one option has a favorable medical benefit-burden ratio compared to other options; and 3) parents' preferences regarding the options; then 4) calibrating the SDM approach based on other relevant decision characteristics. METHODS We videotaped a purposive sample of pediatric inpatient and outpatient encounters at a single US children's hospital. Clinicians from 7 clinical services (craniofacial, neonatology, oncology, pulmonary, pediatric intensive care, hospital medicine, and sports medicine) were eligible. English-speaking parents of children who participated in inpatient family care conferences or outpatient problem-oriented encounters with participating clinicians were eligible. We conducted individual postencounter interviews with clinician and parent participants utilizing video-stimulated recall to facilitate reflection of decision-making that occurred during the encounter. We utilized direct content analysis with open coding of interview transcripts to determine the salience of the 4-step SDM process and identify themes that confirmed, refuted, or modified this process. RESULTS We videotaped 30 encounters and conducted 53 interviews. We found that clinicians' and parents' experiences of decision-making confirmed each SDM step. However, there was variation in the interpretation of each step and a need for flexibility in implementing the process depending on specific decisional contexts. CONCLUSIONS The 4-step SDM process for pediatrics appears to be salient and may benefit from further guidance about the interpretation of each step and contextual factors that support a modified approach.
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Affiliation(s)
- Douglas J Opel
- Division of Bioethics and Palliative and Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (DJ Opel), Seattle, Wash.
| | - Holly Hoa Vo
- Division of Pulmonary and Sleep Medicine and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (HH Vo and BS Wilfond), Seattle, Wash
| | - Nicolas Dundas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (N Dundas, H Spielvogle, and A Mercer), Seattle, Wash
| | - Heather Spielvogle
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (N Dundas, H Spielvogle, and A Mercer), Seattle, Wash
| | - Amanda Mercer
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (N Dundas, H Spielvogle, and A Mercer), Seattle, Wash
| | - Benjamin S Wilfond
- Division of Pulmonary and Sleep Medicine and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (HH Vo and BS Wilfond), Seattle, Wash
| | - Jonna Clark
- Division of Critical Care Medicine and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute (J Clark), Seattle, Wash
| | - Carrie L Heike
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington School of Medicine and Center for Clinical and Translational Research, Seattle Children's Research Institute (CL Heike), Seattle, Wash
| | - Elliott M Weiss
- Division of Neonatology and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine and Treuman Katz Center for Pediatric Bioethics (EM Weiss), Seattle, Wash
| | - Mersine A Bryan
- Division of Hospital Medicine, Department of Pediatrics, University of Washington School of Medicine and Center for Clinical and Translational Research, Seattle Children's Research Institute (MA Bryan), Seattle, Wash
| | - Seema K Shah
- Department of Pediatrics, Northwestern University Feinberg School of Medicine; Bioethics Program, Lurie Children's Hospital (SK Shah), Chicago, Ill
| | - Carolyn A McCarty
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine and Center for Child Health, Behavior, and Development, Seattle Children's Research Institute (CA McCarty), Seattle, Wash
| | - Jeffrey D Robinson
- Department of Communication, Portland State University (JD Robinson), Portland, Ore
| | - Jennifer Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine (J Blumenthal-Barby), Houston, Tex
| | - Jon Tilburt
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic (J Tilburt), Scottsdale, Ariz
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How to hold an effective NICU family meeting: capturing parent perspectives to build a more robust framework. J Perinatol 2021; 41:2217-2224. [PMID: 33883689 PMCID: PMC8058495 DOI: 10.1038/s41372-021-01051-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/01/2021] [Accepted: 03/29/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To record the content and parental perceptions of family meetings in a Neonatal Intensive Care Unit (NICU) to improve existing frameworks for facilitating these meetings. STUDY DESIGN A prospective, mixed-methods study. NICU family meetings were audio-recorded, transcribed, and analyzed by an iteratively derived coding framework until thematic saturation. We used descriptive statistics of parental post-meeting assessments. RESULTS Qualitative analysis of 21 meetings identified both Communication Facilitators and Barriers. Facilitators included use of visual-aids and participation of social workers to clarify information for parents. Barriers included staff rarely eliciting parental comprehension (3 meetings) or concerns (5) before providing new information, resulting in 39% of parents reporting they didn't ask questions they wanted to ask. In 33% of meetings an important participant was absent. CONCLUSIONS This novel qualitative and quantitative dataset of NICU family meetings highlights areas for improving communication. Attention to these components may improve parental perceptions of family meetings.
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Rosenblatt T, Ort K, Shaw R, Levy RJ, Chen C, Niemi A, Hoang K. A Previously Healthy Adolescent With Acute Psychosis and Severe Hyperhidrosis. Pediatrics 2020; 145:peds.2019-3786. [PMID: 32444380 DOI: 10.1542/peds.2019-3786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 11/24/2022] Open
Abstract
A previously healthy 15-year-old boy presented with 3 months of progressive psychosis, insomnia, back and groin pain, and hyperhidrosis. On examination, the patient was disheveled, agitated, and soaked with sweat, with systolic blood pressure in the 160s and heart rate in the 130s. Aside from occasional auditory and visual hallucinations, his neurologic examination was normal. The patient was admitted for an extensive workup, including MRI of the brain and spine and lumbar puncture, which were normal. Through collaboration with various pediatric specialists, including psychiatry and neurology, a rare diagnosis was ultimately unveiled.
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Affiliation(s)
| | - Katherine Ort
- Stanford University School of Medicine and.,Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences
| | - Richard Shaw
- Stanford University School of Medicine and.,Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences
| | - Rebecca J Levy
- Stanford University School of Medicine and.,Division of Child Neurology, Department of Neurology and Neurological Sciences, and
| | - Chen Chen
- Stanford University School of Medicine and.,Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | | | - Kim Hoang
- Stanford University School of Medicine and.,Division of Pediatric Hospital Medicine, Department of Pediatrics, Stanford University, Stanford, California
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5
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Seltzer RR, Raisanen JC, da Silva T, Donohue PK, Williams EP, Shepard J, Boss RD. Medical Decision-Making in Foster Care: Considerations for the Care of Children With Medical Complexity. Acad Pediatr 2020; 20:333-340. [PMID: 31809809 DOI: 10.1016/j.acap.2019.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/22/2019] [Accepted: 11/28/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore how medical decision-making for children with medical complexity (CMC) occurs in the context of foster care (FC). METHODS Together with a medical FC agency, we identified 15 CMC in medical FC and recruited eligible care team members (biological and foster parents, medical FC nurses, caseworkers in medical FC/child welfare, and pediatricians) for each child. Semistructured interviews were conducted, and conventional content analysis was applied to transcripts. RESULTS Fifty-eight interviews were completed with 2-5 care team members/child. Serious decision-making related to surgeries and medical technology was common. Themes regarding medical decision-making for CMC in FC emerged: 1) Protocol: decision-making authority is dictated by court order and seriousness of decision, 2) Process: decision-making is dispersed among many team members, 3) Representing the child's interests: the majority of respondents stated that the foster parent represents the child's best interests, while the child welfare agency should have legal decision-making authority, and 4) Perceived barriers: serious medical decision-making authority is often given to individuals who spend little time with the child. CONCLUSIONS Medical decisions for CMC can have uncertain risk/benefit ratios. For CMC in FC, many individuals have roles in these nuanced decisions; those with ultimate decision-making authority may have minimal interaction with the child. Pediatricians can assist by clarifying who has legal decision-making authority, facilitating team communication to promote truly informed consent, and serving as a resource to decision-makers. Further research should explore how to adapt the traditional model of shared decision-making to meet the needs of this population.
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Affiliation(s)
- Rebecca R Seltzer
- Johns Hopkins University School of Medicine (RR Seltzer, PK Donohue, J Shepard, RD Boss), Baltimore, Md; Berman Institute of Bioethics (RR Seltzer, JC Raisanen, RD Boss), Baltimore, Md.
| | - Jessica C Raisanen
- Berman Institute of Bioethics (RR Seltzer, JC Raisanen, RD Boss), Baltimore, Md
| | - Trisha da Silva
- Johns Hopkins Bloomberg School of Public Health (T da Silva, PK Donohue), Baltimore, Md
| | - Pamela K Donohue
- Johns Hopkins University School of Medicine (RR Seltzer, PK Donohue, J Shepard, RD Boss), Baltimore, Md; Johns Hopkins Bloomberg School of Public Health (T da Silva, PK Donohue), Baltimore, Md
| | - Erin P Williams
- Columbia University Vagelos College of Physicians and Surgeons (EP Williams), New York, NY
| | - Jennifer Shepard
- Johns Hopkins University School of Medicine (RR Seltzer, PK Donohue, J Shepard, RD Boss), Baltimore, Md
| | - Renee D Boss
- Johns Hopkins University School of Medicine (RR Seltzer, PK Donohue, J Shepard, RD Boss), Baltimore, Md; Berman Institute of Bioethics (RR Seltzer, JC Raisanen, RD Boss), Baltimore, Md
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Walter JK, Arnold RM, Curley MAQ, Feudtner C. Teamwork When Conducting Family Meetings: Concepts, Terminology, and the Importance of Team-Team Practices. J Pain Symptom Manage 2019; 58:336-343. [PMID: 31051202 PMCID: PMC6800049 DOI: 10.1016/j.jpainsymman.2019.04.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 11/18/2022]
Abstract
Family meetings, which bring together members of a seriously ill patient's family and the interprofessional team (IPT), have been widely recognized as promoting shared decision-making for hospitalized patients, particularly those in intensive care units. The planning and conducting of interprofessional family meetings are hampered, however, by a lack of clarity about who is doing what and when, which in turn can lead to inefficiencies and uncoordinated efforts. This article describes how members of the IPT interact with one another (what we have termed team-team practices), distinguishing these interactions from how the IPT engages directly with family members (team-family practices) in preparing for and conducting family meetings. Although most research and guidelines have focused on team-family practices that directly affect patient- and family-level outcomes (e.g., safety and satisfaction), team-team practices are needed to coordinate team contributions and optimize the skills of the diverse team. Team members' knowledge and attitudes also contribute to patient and family outcomes as well as team outcomes. Yet without attention to team-team practices before, during, and after a family meeting, the family-level outcomes are less likely to be achieved as are team well-being outcomes (e.g., reduced burnout and staff retention). Drawing upon team theory, we present a set of key concepts and corresponding terms that enable a more precise description of team-team practices and team-family practices, aiming to help with team training and evaluation and to enable future research of these distinct yet inter-related practices.
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Affiliation(s)
- Jennifer K Walter
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
| | - Robert M Arnold
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Martha A Q Curley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Chris Feudtner
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
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Moore D. We Are All "With the Band": Palliative Care Specialists, Generalists, and the Good We Do Together. Hosp Pediatr 2019; 9:220-222. [PMID: 30770413 DOI: 10.1542/hpeds.2018-0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Dominic Moore
- Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, Utah
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Diamonstein CJ. Factors complicating the informed consent process for whole exome sequencing in neonatal and pediatic intensive care units. J Genet Couns 2019; 28:256-262. [DOI: 10.1002/jgc4.1097] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Callie J. Diamonstein
- Division of Medical Genomics; Inova Translational Medicine Institute; Falls Church Virginia
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Archambault-Grenier MA, Roy-Gagnon MH, Gauvin F, Doucet H, Humbert N, Stojanovic S, Payot A, Fortin S, Janvier A, Duval M. Survey highlights the need for specific interventions to reduce frequent conflicts between healthcare professionals providing paediatric end-of-life care. Acta Paediatr 2018; 107:262-269. [PMID: 28793184 DOI: 10.1111/apa.14013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/28/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
AIMS This study explored how paediatric healthcare professionals experienced and coped with end-of-life conflicts and identified how to improve coping strategies. METHODS A questionnaire was distributed to all 2300 professionals at a paediatric university hospital, covering the frequency of end-of-life conflicts, participants, contributing factors, resolution strategies, outcomes and the usefulness of specific institutional coping strategies. RESULTS Of the 946 professionals (41%) who responded, 466 had witnessed or participated in paediatric end-of-life discussions: 73% said these had led to conflict, more frequently between professionals (58%) than between professionals and parents (33%). Frequent factors included professionals' rotations, unprepared parents, emotional load, unrealistic parental expectations, differences in values and beliefs, parents' fear of hastening death, precipitated situations and uncertain prognosis. Discussions with patients and parents and between professionals were the most frequently used coping strategies. Conflicts were frequently resolved by the time of death. Professionals mainly supported designating one principal physician and nurse for each patient, two-step interdisciplinary meetings - between professionals then with parents - postdeath ethics meetings, bereavement follow-up protocols and early consultations with paediatric palliative care and clinical ethics services. CONCLUSION End-of-life conflicts were frequent and predominantly occurred between healthcare professionals. Specific interventions could target most of the contributing factors.
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Affiliation(s)
| | - Marie-Hélène Roy-Gagnon
- Centre de Recherche; CHU Sainte-Justine; Université de Montréal; Montréal QC Canada
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa ON Canada
| | - France Gauvin
- Département de Pédiatrie; CHU Sainte-Justine; Université de Montréal; Montréal QC Canada
- Unité de Consultation en Soins Palliatifs Pédiatriques; CHU Sainte-Justine; Montréal QC Canada
| | - Hubert Doucet
- Comité de Bioéthique; CHU Sainte-Justine; Montréal QC Canada
| | - Nago Humbert
- Département de Pédiatrie; CHU Sainte-Justine; Université de Montréal; Montréal QC Canada
- Unité de Consultation en Soins Palliatifs Pédiatriques; CHU Sainte-Justine; Montréal QC Canada
| | - Sanja Stojanovic
- Département de Pédiatrie; CHU Sainte-Justine; Université de Montréal; Montréal QC Canada
- Centre de Réadaptation Marie-Enfant; CHU Sainte-Justine; Montréal QC Canada
| | - Antoine Payot
- Département de Pédiatrie; CHU Sainte-Justine; Université de Montréal; Montréal QC Canada
- Unité de Consultation en Soins Palliatifs Pédiatriques; CHU Sainte-Justine; Montréal QC Canada
- Comité de Bioéthique; CHU Sainte-Justine; Montréal QC Canada
- Unité de Consultation en Éthique Clinique; CHU Sainte-Justine; Montréal QC Canada
| | - Sylvie Fortin
- Département de Pédiatrie; CHU Sainte-Justine; Université de Montréal; Montréal QC Canada
- Comité de Bioéthique; CHU Sainte-Justine; Montréal QC Canada
- Unité de Consultation en Éthique Clinique; CHU Sainte-Justine; Montréal QC Canada
| | - Annie Janvier
- Département de Pédiatrie; CHU Sainte-Justine; Université de Montréal; Montréal QC Canada
- Unité de Consultation en Éthique Clinique; CHU Sainte-Justine; Montréal QC Canada
- Soins Intensifs Néonataux; CHU Sainte-Justine; Montréal QC Canada
| | - Michel Duval
- Service d'Hématologie-Oncologie; Centre de Cancérologie Charles-Bruneau; Montréal QC Canada
- Département de Pédiatrie; CHU Sainte-Justine; Université de Montréal; Montréal QC Canada
- Unité de Consultation en Soins Palliatifs Pédiatriques; CHU Sainte-Justine; Montréal QC Canada
- Unité de Consultation en Éthique Clinique; CHU Sainte-Justine; Montréal QC Canada
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Drago MJ. Making Sense of the Surreal: Guiding Families and Patients When Last-Ditch Medical Efforts Fail. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2018; 18:30-31. [PMID: 29313772 DOI: 10.1080/15265161.2017.1401173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Adams RC, Levy SE. Shared Decision-Making and Children With Disabilities: Pathways to Consensus. Pediatrics 2017; 139:peds.2017-0956. [PMID: 28562298 DOI: 10.1542/peds.2017-0956] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Shared decision-making (SDM) promotes family and clinician collaboration, with ultimate goals of improved health and satisfaction. This clinical report provides a basis for a systematic approach to the implementation of SDM by clinicians for children with disabilities. Often in the discussion of treatment plans, there are gaps between the child's/family's values, priorities, and understanding of perceived "best choices" and those of the clinician. When conducted well, SDM affords an appropriate balance incorporating voices of all stakeholders, ultimately supporting both the child/family and clinician. With increasing knowledge of and functional use of SDM skills, the clinician will become an effective partner in the decision-making process with families, providing family-centered care. The outcome of the process will support the beneficence of the physician, the authority of the family, and the autonomy and well-being of the child.
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Affiliation(s)
- Richard C. Adams
- aUniversity of Texas Southwestern Medical Center, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Susan E. Levy
- bCenter for Autism Research, Division Developmental and Behavioral Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- cPerelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
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Brittan M, Albright K, Cifuentes M, Jimenez-Zambrano A, Kempe A. Parent and Provider Perspectives on Pediatric Readmissions: What Can We Learn About Readiness for Discharge? Hosp Pediatr 2015; 5:559-65. [PMID: 26526801 DOI: 10.1542/hpeds.2015-0034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Readmissions are an increasingly recognized quality metric that will likely affect payments to children's hospitals. Our aim was to inform future efforts to reduce readmissions by eliciting parent and provider perceptions of pediatric readmissions. METHODS We interviewed English- and Spanish-speaking parents and inpatient providers of children with medical diagnoses who had unplanned readmissions (≤7 days). Parents were interviewed one-on-one during the readmission. Providers were interviewed in person or by phone within 1 week of the patient's second discharge. Interviewees were queried about their perceptions of the reason for readmission and whether the readmission was preventable. Interview transcripts were analyzed using qualitative content methods. Code categories were developed and emergent themes independently identified by 2 analysts. RESULTS The study included 30 readmitted children (median age 17 months, 70% male, 80% White or Hispanic, and 66% publically insured). We interviewed 30 parents (23% Spanish speaking) and 27 discharging or readmitting providers. Parents and providers identified several major factors as causing readmissions, including child related (health and symptoms), parent/family related (adherence to recommended care), provider/team related (medical management), communication difficulties, home supports, and quality of discharge teaching. Parents and providers had differing interpretations of the role or magnitude of these factors. Lack of shared understanding between parents and providers emerged as a potentially important cause of readmissions. CONCLUSIONS We identified lack of shared understanding and communication difficulties between parents and providers as potential causes of readmission. Further research is needed to determine if improvements in identifying and addressing such problems can reduce pediatric readmissions.
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Affiliation(s)
- Mark Brittan
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; and
| | - Karen Albright
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Maribel Cifuentes
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Andrea Jimenez-Zambrano
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado
| | - Allison Kempe
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; and
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Pediatric palliative care: current evidence and evidence gaps. J Pediatr 2015; 166:1536-40.e1. [PMID: 25799195 DOI: 10.1016/j.jpeds.2015.02.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/30/2015] [Accepted: 02/06/2015] [Indexed: 11/23/2022]
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