107 - Developing Sensitive and Reliable Criteria for Pediatric Intensive Care Unit Family Care Conferences

Poster Number: 107
Publication Number: 107.307

Kelly N. Michelson, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Lauren R. Sorce, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Sangeeta schroeder, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Michela Primavera, Advocate Children's Hospital - Park Ridge, Carol Stream, IL, United States; Rani Ganesan, Advocate Children's Hospital - Park Ridge, Park Ridge, IL, United States

Background: Experts recommend multidisciplinary intensive care unit (ICU) family care conferences (FCCs) to improve communication. Little is known about which pediatric ICU (PICU) patient families should be offered FCCs.

Objective: Develop sensitive criteria that identify families of PICU patients who might benefit from an FCC and are reliably ascertained from patient electronic health records (EHR).

Design/Methods: We defined FCCs as planned discussions (excluding bedside rounds and bedside updates) with multiple care team members and parents/patient surrogates. A multidisciplinary team from two sites: first, combined expert input and assessment of the current state using existing literature to create preliminary criteria; second, evaluated the preliminary criteria using retrospective EHR review of 1-month of PICU patients and EHR documentation to identify if an FCC occurred; and third, evaluated the revised criteria using prospective EHR review of 2-months of PICU patients using EHR documentation and real-time clinician input to identify if an FCC occurred. We calculated sensitivity as the proportion of patients with at least 1 criterion who had an FCC among all patients who had an FCC. We calculated reliability as percent agreement between two reviewers who identified patients with an FCC criterium during the prospective EHR review.

Results: We defined 15 unique FCC criteria in 5 domains: illness severity; goals of care discussion; discharge planning; prolonged PICU admission (including family factors or chronic medical condition); and family/clinician request. (Table 1) We retrospectively reviewed 180 patient EHRs. Of 110 patients without an FCC criterium none had an FCC. 70/180 patients (39%) had an FCC criterium, of whom 62/70 (89%) had no FCC (sensitivity 100%/specificity 64%). Given the high sensitivity, we used the same criteria to prospectively review 315 patient EHRs. Of 247 patients without an FCC criterium, 1 had an FCC. 68/315 patients (22%) had an FCC criterium, of whom 58/68 (85%) had no FCC (sensitivity 91%/specificity 81%). Percent agreement was >80% for all domains except prolonged PICU admission with family factors and family/clinician request.  Conclusion(s): Multidisciplinary experts from 2 sites defined 15 FCC criteria in 5 domains which identified most patients who had FCCs. ≥85% of patients with an FCC criterion did not have an FCC. Reliability was strong for all domains except prolonged PICU admission and family/clinician request. Our next step is to offer families an FCC who meet an FCC criterium and determine if FCC use increases.
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