Primary Intensivists and Primary Nurses to Decrease Pediatric ICU Length of Stay
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | Any |
| Updated: | 4/17/2018 |
| Start Date: | February 1, 2018 |
| End Date: | June 2019 |
| Contact: | Jeffrey Edwards, MD |
| Email: | jde2134@cumc.columbia.edu |
| Phone: | 2123058458 |
This is a randomized control trial of PICU patients admitted for 7 days and expected to
remain for at least another 3 days and who have a complex chronic condition. Patients will be
randomized to usual care or usual care plus a primary intensivist and group of primary nurses
(to facilitate passing of important patient information and informed, expedited
decision-making). The primary research question is whether having a primary intensivist and
nurses decreases PICU length of stay.
remain for at least another 3 days and who have a complex chronic condition. Patients will be
randomized to usual care or usual care plus a primary intensivist and group of primary nurses
(to facilitate passing of important patient information and informed, expedited
decision-making). The primary research question is whether having a primary intensivist and
nurses decreases PICU length of stay.
Long-stay intensive care unit (ICU) patients, or children who require prolonged
hospitalization in the pediatric ICU (PICU), represent a minority of PICU patients but have a
disproportionate impact on hospital resources and unfavorable outcomes, including morbidity,
mortality, and repeated critical illness. These patients and their families have multifaceted
needs (eg, tailored communication) that pose unique challenges to PICU providers and the
parent-provider relationship. These experiences and needs are compounded and complicated by
the transitory care that is typically provided by PICU. This transitory care may contribute
to 1) patient/family dissatisfaction; 2) ineffective passing of important information day to
day and week to week; and 3) delayed decision-making. These latter two potential consequences
may, in turn, contribute to prolonged length of stay (LOS).
For these reasons, the investigators propose a randomized control trial to test whether
primary intensivists and primary nurses can decrease PICU LOS for long-stay patients. A
primary intensivist is one that remains a consistent physician-presence for the
patient/family and PICU team throughout the child's PICU stay, despite changes in the
intensivist(s) who orchestrates day-to-day management. Primary nurses are a team of PICU
nurses who provide the all/most of the bedside care to the child. The investigators
hypothesize that the long-stay PICU patients who are randomized to receive primary
intensivists and nurses will have a statistically lower LOS than those patients who do not.
hospitalization in the pediatric ICU (PICU), represent a minority of PICU patients but have a
disproportionate impact on hospital resources and unfavorable outcomes, including morbidity,
mortality, and repeated critical illness. These patients and their families have multifaceted
needs (eg, tailored communication) that pose unique challenges to PICU providers and the
parent-provider relationship. These experiences and needs are compounded and complicated by
the transitory care that is typically provided by PICU. This transitory care may contribute
to 1) patient/family dissatisfaction; 2) ineffective passing of important information day to
day and week to week; and 3) delayed decision-making. These latter two potential consequences
may, in turn, contribute to prolonged length of stay (LOS).
For these reasons, the investigators propose a randomized control trial to test whether
primary intensivists and primary nurses can decrease PICU LOS for long-stay patients. A
primary intensivist is one that remains a consistent physician-presence for the
patient/family and PICU team throughout the child's PICU stay, despite changes in the
intensivist(s) who orchestrates day-to-day management. Primary nurses are a team of PICU
nurses who provide the all/most of the bedside care to the child. The investigators
hypothesize that the long-stay PICU patients who are randomized to receive primary
intensivists and nurses will have a statistically lower LOS than those patients who do not.
Inclusion Criteria:
- PICU patients of any age who
- have a complex chronic condition
- have been admitted to the PICU for one week and are predicted by the PICU
attending to continue to be admitted for at least another 3 days.
Exclusion Criteria:
We found this trial at
1
site
Columbia University Medical Center Situated on a 20-acre campus in Northern Manhattan and accounting for...
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