Clinical trial NCT03364933: Primary Intensivists and Primary Nurses to Decrease Pediatric ICU Length of Stay
Official title: Primary Intensivists and Primary Nurses to Decrease Pediatric ICU Length of Stay
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: ICU Length of Stay
Keywords: Child
Critical Illness
Length of Stay
Satisfaction
Lead sponsor: Columbia University
Sponsor class: OTHER
First posted: 2017-12-07
Enrollment: 200
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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.

Detailed description: 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.

Eligibility criteria: 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:

-

Primary outcomes:
measure: PICU length of stay
timeFrame: Up to 2 years
Secondary outcomes:
measure: Family satisfaction
timeFrame: Up to 2 years
measure: Provider satisfaction
timeFrame: Up to 2 years
measure: Percentage of family meetings attended by a primary nurse
timeFrame: Up to 2 years
measure: Duration of invasive mechanical ventilation in those patients without chronic respiratory failure and who are on invasive mechanical ventilation from the time of enrollment
timeFrame: Up to 2 years
measure: Time to tracheotomy in those who undergo a tracheotomy
timeFrame: Up to 2 years
measure: Incidence of nursing-related KEEPSAFE reports recorded after enrollment
timeFrame: Up to 2 years
measure: Timing of involvement of Patient Care Services
timeFrame: Up to 2 years
measure: Incidence of ICU-acquired infections after enrollment
timeFrame: Up to 2 years
measure: Number of documented family meetings
timeFrame: Up to 2 years
measure: Incidence of unplanned re-admissions to a PICU within 48 hours of PICU discharge
timeFrame: Up to 2 years
measure: Percentage of primary intensivists who meet with families
timeFrame: Up to 2 years
measure: Total number of shifts that are not being covered by a primary nurse,
timeFrame: Up to 2 years
Other outcomes:
Locations:
city: New York
country: United States
facility: Columbia University Medical Center
state: New York
Study officials:
affiliation: Columbia University
name: Jeffrey Edwards, MD
role: PRINCIPAL_INVESTIGATOR
References: