Pediatric Continuity Care Intensivist (CCI)

Children's Hospital of Philadelphia (CHOP)

Status: Completed

Conditions: Critical Illness

Treatments: Behavioral: Continuity Care Intensivist Communication Training; Behavioral: Continuity Care Intensivist (CCI) Provider Program

Study type: Interventional

Funder types: Other

Identifiers

NCT02146573

IRB 14-010987

Details and patient eligibility

About

This study will implement and evaluate the effects of a pediatric continuity care intensivist program. This study will determine the impact of an additional pediatric intensive care unit (PICU) intensivist on outcomes at the patient and family level. It will also evaluate the training program to prepare the continuity care intensivist (CCI).

Full description

This randomized controlled trial will implement and evaluate the effects of a pediatric continuity care intensivist (CCI) program. The study will evaluate how effective the modified communication training for providers is to perform this new role. The primary outcome for the study is whether a CCI will affect several patient level outcomes for patients who have been admitted to the PICU longer than 7 days. Patient length of stay, hospital acquired conditions, time to limitations of interventions and new medical technology will be assessed comparing the intervention and usual care arms. The study will also determine the impact of the CCI program on parent/family satisfaction with provider communication and decision-making for their child.

Enrollment: 276 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

CCI Provider

1. Pediatric Intensive Care Unit Attending Physician who volunteers to serve in the role of CCI.

Usual Care (UC) Provider

1. Any Pediatric Intensive Care Unit Attending Physician who is not enrolled as a CCI.

Parent-Patient Dyads

1. Parent/guardian of a child who has been admitted to the Children's Hospital of Philadelphia (CHOP) PICU for ≥7 days after onset of the study
2. Parent/guardian ≥ 18 years old
3. Parent/guardian is English-speaking
4. Child <18 years old at time of enrollment
5. Child has been admitted to the PICU at CHOP for ≥7 days
6. Medical team believed that patient will remain in the PICU for at least another seven days

Exclusion criteria

CCI Provider

1. Any medical care provider who is not an attending physician (e.g., Pediatric critical care residents, nurses, and fellows)

UC Provider

1. Any medical care provider who is not an attending physician (e.g., Pediatric critical care residents, nurses, and fellows)
2. Attending physician who is enrolled in the study as a CCI

Parent-Patient Dyads

1. Parent or guardian who has previously participated in the CCI study in a previous hospitalization (in either usual care or intervention arm)
2. Parent or guardian of a child who has already been hospitalized in the PICU >7 days at the onset of the study.
3. Child ≥18 years of age at time of enrollment
4. Child has previously participated in the CCI study in a previous PICU stay (in either usual care or intervention arm)
5. Child has been hospitalized in the PICU >7 days at the onset of the study
6. Child already has a "primary" attending
7. Child has a sibling that has already been enrolled in the study. This child will be ineligible for the study but will be assigned to the same care as the child who is or was enrolled in the study.
8. If contact was not established for enrollment by 14 days after admission, then the patient was no longer considered eligible for enrollment to maintain comparability of length of stay at enrollment.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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276 participants in 2 patient groups

CCI Provider for Parent-patient dyad

Experimental group

Description:

Parents and patients are randomly assigned to a Continuity Care Intensivist (CCI) Provider who has received specialized communication training. The parent-patient dyad will receive standardized care from the CCI throughout their time in the PICU in addition to being assigned a rotating physician of record.

Treatment:

Behavioral: Continuity Care Intensivist (CCI) Provider Program

Behavioral: Continuity Care Intensivist Communication Training

Usual Care for Parent-patient dyad

No Intervention group

Description:

Patients and parents randomly assigned to usual care in the PICU which includes the rotation of the physician of record approximately every 7 days. There is no standardized process by which patients may be assigned a primary attending who would follow them throughout their stay. In the usual care arm it may never happen that they are assigned a primary intensivist, regardless of the length of their hospitalization.