24 - Mapping the Care Team in Pediatric Critical Illness

Poster Number: 24
Publication Number: 24.201

Miriam C. Shapiro, University of Minnesota Medical School, Minneapolis, MN, United States; Andrew Olson, University of Minnesota Medical School, Minneapolis, MN, United States; Morgan Kerfeld, University of Minnesota, North Oaks, MN, United States; Nathan Rubin, University of Minnesota, Minneapolis, MN, United States; Marianna Finney, University of Minnesota Masonic Children's Hospital, Maple Grove, MN, United States; Priti P. Shah, University of Minnesota, Minneapolis, MN, United States

Background: Intensive care unit (ICU) teams are template teams, where different people fill clearly delineated roles each day. Different people with the same training may make different decisions when presented with the same clinical scenario, which can impact consistency in patient care over time. Long stay patients are increasingly prevalent in pediatric ICUs; they experience frequent care team reorganization with rotation of providers and varying involvement of consultants as medical status evolves. Dynamic team composition impacts diagnostic & management reasoning, communication, & patient/family experience. Understanding the composition & behaviors of ICU teams over time is a first step to identifying and promoting teamwork best practices.

Objective: To describe how clinician team composition varies depending on length of stay (LOS), identify team trends over time, & target areas for future inquiry.

Design/Methods: Retrospective chart review including patients aged 0-21 years admitted to a tertiary academic hospital’s pediatric and cardiovascular ICUs in March & September 2019. Exclusion criteria were research opt-out & admission for cardiac surgery. All eligible patients with LOS≥7 days were included; short stay patients were chosen randomly for inclusion. We collected demographics, ICU LOS, name & specialty of each clinician who signed a note during the ICU stay of each patient. Demographic & clinical team factors were compared between LOS groups using t-tests or Fisher’s Exact tests, as appropriate.

Results: 21 patients with LOS≥7 days & 14 patients with LOS < 7 days accounted for 3716 encounters by >294 unique clinicians. Demographics, LOS, number of unique clinicians and specialties are described in Table 1. ICU clinicians accounted for 36.5% of encounters. The number of unique clinicians involved in a patient’s care increased linearly through LOS 50 days before starting to plateau; the number of unique specialties was variable for the first 2 ICU weeks, demonstrating an increasing trend for all with LOS ≥7 days (Figure 1).Conclusion(s): This project contributes to our understanding of medical and management research through investigating teams that are dynamically changing. Patient exposure to new individual clinicians increases throughout ICU stay-even after weeks of hospitalization-appearing to plateau only for patients with LOS >50 days. Future work will investigate behaviors within these dynamic teams, impacts on team and patient outcomes, and strategies to maximize benefits of diverse involvement while mitigating negative effects of substantial care team variation during high-risk hospitalizations.
Table 1: Demographics,Clinical, and Team Factors by LOS StatusLOS Status < or ≥ 7 days; Numeric measures tested with t-test, categorical with Fisher’s Exact test
Figure 1: Number of Unique Clinicians and Specialties vs Length of StayFigure 1.jpegA. Number of unique clinicians vs LOS 0-200 days; B. Number of unique clinicians vs LOS first 35 days only; C. Number of unique specialties vs LOS 0-200 days; D. Number of unique specialties vs LOS first 35 days only