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Critical Care Medicine ; 51(1 Supplement):279, 2023.
Article in English | EMBASE | ID: covidwho-2190576


INTRODUCTION: Families are often not present at the bedside during their child's pediatric intensive care unit (PICU) admission. Family presence is important for participation in family-centered care (FCC), promoted by the American Academy of Pediatrics to improve health outcomes. It is unknown if demographic characteristics are associated with family presence during peak illness severity, the first 72 hours of admission. We describe associations between demographic characteristics and family presence during peak illness severity. METHOD(S): We performed a retrospective observational study of PICU admissions > 72 hours from July 2012-June 2021 at a single tertiary care children's hospital to determine associations with our primary outcome of bedside family presence percentage in the first 72 hours of admission. Predictor variables included patient and family demographic characteristics obtained from the electronic medical record. We completed descriptive bivariate analyses of the predictor variables and family presence percentage (Spearman Rho for continuous variables and Kruskal Wallis for categorical variables). RESULT(S): 3006 unique patients were included. Family members were present a mean of 81% and a median of 97% of the first 72 hours. Family presence percentage was weakly positively correlated with age (rs=0.108, p< 0.001) and weakly negatively correlated with length of stay (rs=-0.253, p< 0.001) and PELOD-2 score (rs=-0.217, p< 0.001). Decreased median family presence percentage was associated with Black race (81.1 v 97.2-98.1 all other races, p=< 0.001), non-Hispanic ethnicity (95.8 v 97.2 Hispanic ethnicity, p< 0.001), public insurance (94.8 v private 98.4, p< 0.001), and admissions after COVID (94.2 v 96.6 pre- COVID, p< 0.001). Increased family presence percentage was associated with Spanish speaking families (97.9 v 96.2 English, p = 0.01). Family presence percentage was not associated with distance from hospital, complex care conditions, or siblings. CONCLUSION(S): Family presence percentage during peak illness severity is associated with patient demographic characteristics. Families of racially and ethnically diverse patients and with public insurance may benefit from interventions to increase their ability to be present at the bedside.

Critical Care Medicine ; 51(1 Supplement):127, 2023.
Article in English | EMBASE | ID: covidwho-2190504


INTRODUCTION: In 2011, the task force on Pediatric Emergency Mass Critical Care (PEMCC) noted that no North American emergency had overwhelmed ICU services since the modern development of critical care. During the COVID-19 global pandemic, resource allocation became a challenge and healthcare workers' opinions of resource allocation had not been rigorously addressed in the literature. Our primary goal was to elucidate PICU providers' opinions of various resource allocation strategies. METHOD(S): An anonymous, electronic survey was sent to 173 PICU providers at a single institution - 47 MDs/APRNs and 126 RNs. Seven strategies for resource allocation were surveyed: (1) likelihood of survival;(2) age;(3) baseline neurologic status;(4) predicted length of time requiring resource;(5) lottery system;(6) first come first served;(7) immigration status. Each strategy was surveyed by three methods. First, a simple yes/no format was used to survey support of each resource allocation strategy. Second, the survey presented case scenarios and asked participants to choose a patient to receive the resource. Finally, participants ranked the strategies by importance. We analyzed data using descriptive statistics and average numerical rank. RESULT(S): Respondents included 19 MD/DOs/APRNs and 23 RNs. 85.7% believed the hospital should have a scarce resource allocation protocol. In response to various resource allocation strategies, participant "yes" responses were: 100% likelihood of survival;83% baseline neurologic status;81% time scarce resource required;64% age;5% first come first served;5% lottery system;2% immigration status. For case scenarios, majority of participants chose patients with a higher likelihood of survival, shorter time requiring scare resource and/or previously healthy status. The average rank of each strategy (most important scored 1): Likelihood of survival 1.14;Baseline neurologic status 2.98;Predicted length of time requiring resource 3.02;Age 3.9;Lottery system 4.81;First come first served 5.29;Immigration status 6.86. CONCLUSION(S): Likelihood of survival plays a consistently important role in determining resource allocation for PICU providers. Majority of providers believe a lottery system should not be used, yet many select a lottery system approach when faced with clinical scenarios.