Planning the Discharge from Paediatric Intensive Care of a Child with Complex Care Needs
Main Article Content
Abstract
Many children admitted to the Paediatric Intensive Care for management of serious illness recover quickly. This is reflected in a mean length of stay is <5 days for many tertiary level critical care units. A small proportion of infants and children require a prolonged paediatric intensive care stay, due to the severity of their illness, complexity of medical and nursing care required, and presence of underlying co-morbidity. This cohort of patients have particular needs when being discharged to ward level care, and onwards to home. This paper reviews the complex care that patients may require in the first days and weeks following discharge from paediatric intensive care. Supported by available published literature, the authors outline the key relevant themes, and make recommendations on how transition to the ward may be facilitated.
Article Details
How to Cite
MCALLISTER, Maeve et al.
Planning the Discharge from Paediatric Intensive Care of a Child with Complex Care Needs.
Medical Research Archives, [S.l.], v. 9, n. 3, mar. 2021.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/2361>. Date accessed: 28 dec. 2024.
doi: https://doi.org/10.18103/mra.v9i3.2361.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Paediatric Intensive Care Audit Network (PICANet). Paediatric intensive care audit network annual report (2019) 2019 [Available from: https://www.picanet.org.uk/wp-content/uploads/sites/25/2019/12/PICANet-2019-Annual-Report-Summary_v1.0.pdf.
2. Ilan R, LeBaron CD, Christianson MK, Heyland DK, Day A, Cohen MD. Handover patterns: an observational study of critical care physicians. BMC Health Serv Res. 2012;12:11.
3. Brenner M, Kidston C, Hilliard C, Coyne I, Eustace-Cook J, Doyle C, et al. Children's complex care needs: a systematic concept analysis of multidisciplinary language. Eur J Pediatr. 2018;177(11):1641-52.
4. Zimmerman JJ, Banks R, Berg RA, Zuppa A, Newth CJ, Wessel D, et al. Critical Illness Factors Associated With Long-Term Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock. Crit Care Med. 2020;48(3):319-28.
5. Wood D, McShane P, Davis P. Tracheostomy in children admitted to paediatric intensive care. Arch Dis Child. 2012;97(10):866-9.
6. Fraser LK, Fleming T, Miller M, Draper ES, McKinney PA, Parslow RC, et al. Palliative care discharge from paediatric intensive care units in Great Britain. Palliat Med. 2010;24(6):608-15.
7. Harris J, Ramelet AS, van Dijk M, Pokorna P, Wielenga J, Tume L, et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals. Intensive Care Med. 2016;42(6):972-86.
8. Chiu AW, Contreras S, Mehta S, Korman J, Perreault MM, Williamson DR, et al. Iatrogenic Opioid Withdrawal in Critically Ill Patients: A Review of Assessment Tools and Management. Ann Pharmacother. 2017;51(12):1099-111.
9. Amigoni A, Mondardini MC, Vittadello I, Zaglia F, Rossetti E, Vitale F, et al. Withdrawal Assessment Tool-1 Monitoring in PICU: A Multicenter Study on Iatrogenic Withdrawal Syndrome. Pediatr Crit Care Med. 2017;18(2):e86-e91.
10. Vipond JM, Heiberger AL, Thompson PA, Huber JN. Shortened Taper Duration after Implementation of a Standardized Protocol for Iatrogenic Benzodiazepine and Opioid Withdrawal in Pediatric Patients: Results of a Cohort Study. Pediatr Qual Saf. 2018;3(3):e079.
11. Sanavia E, Mencia S, Lafever SN, Solana MJ, Garcia M, Lopez-Herce J. Sedative and Analgesic Drug Rotation Protocol in Critically Ill Children With Prolonged Sedation: Evaluation of Implementation and Efficacy to Reduce Withdrawal Syndrome. Pediatr Crit Care Med. 2019;20(12):1111-7.
12. Joint Commission on Accreditation of Healthcare Organizations U. Using medication reconciliation to prevent errors. Sentinel Event Alert. 2006(35):1-4.
13. Bosma LBE, Hunfeld NGM, Quax RAM, Meuwese E, Melief P, van Bommel J, et al. The effect of a medication reconciliation program in two intensive care units in the Netherlands: a prospective intervention study with a before and after design. Ann Intensive Care. 2018;8(1):19.
14. Brenner M, Alexander D, Quirke MB, Eustace-Cook J, Leroy P, Berry J, et al. A systematic concept analysis of 'technology dependent': challenging the terminology. Eur J Pediatr. 2021;180(1):1-12.
15. Brenner M, O'Shea MP, Larkin P, Berry J. Key constituents for integration of care for children assisted with long-term home ventilation: a European study. BMC Pediatr. 2020;20(1):71.
16. Hartman AG, Terhorst L, Little N, Bendixen RM. Uncovering sleep in young males with Duchenne muscular dystrophy. Eur J Paediatr Neurol. 2020;26:20-8.
17. Statile AM, Schondelmeyer AC, Thomson JE, Brower LH, Davis B, Redel J, et al. Improving Discharge Efficiency in Medically Complex Pediatric Patients. Pediatrics. 2016;138(2).
18. Weller J, Boyd M, Cumin D. Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgrad Med J. 2014;90(1061):149-54.
19. Manthous C, Nembhard IM, Hollingshead AB. Building effective critical care teams. Crit Care. 2011;15(4):307.
20. Prince E, Gerstenblith TA, Davydow D, Bienvenu OJ. Psychiatric Morbidity After Critical Illness. Crit Care Clin. 2018;34(4):599-608.
21. Parker AM, Bienvenu OJ. Posttraumatic stress disorder symptoms among family decision makers and the potential relevance of study attrition. Crit Care Med. 2015;43(6):1334-5.
22. Whiting M. Impact, meaning and need for help and support: The experience of parents caring for children with disabilities, life-limiting/life-threatening illness or technology dependence. J Child Health Care. 2013;17(1):92-108.
23. Caffin CL, Linton S, Pellegrini J. Introduction of a liaison nurse role in a tertiary paediatric ICU. Intensive Crit Care Nurs. 2007;23(4):226-33.
24. Ekim A. The Post-Intensive Care Syndrome in Children. Compr Child Adolesc Nurs. 2020;43(1):15-21.
25. Lee M, Kang J, Jeong YJ. Risk factors for post-intensive care syndrome: A systematic review and meta-analysis. Aust Crit Care. 2020;33(3):287-94.
26. Watson RS, Choong K, Colville G, Crow S, Dervan LA, Hopkins RO, et al. Life after Critical Illness in Children-Toward an Understanding of Pediatric Post-intensive Care Syndrome. J Pediatr. 2018;198:16-24.
27. Sobotka SA, Dholakia A, Berry JG, Brenner M, Graham RJ, Goodman DM, et al. Home nursing for children with home mechanical ventilation in the United States: Key informant perspectives. Pediatr Pulmonol. 2020;55(12):3465-76.
28. Munoz-Bonet JI, Lopez-Prats JL, Flor-Macian EM, Cantavella T, Bonet L, Dominguez A, et al. Usefulness of telemedicine for home ventilator-dependent children. J Telemed Telecare. 2020;26(4):207-15.
29. Lynch J, Cope V, Murray M. The Intensive Care Unit Liaison Nurse and their value in averting clinical deterioration: A qualitative descriptive study. Intensive Crit Care Nurs. 2020:103001.
30. Niven DJ, Bastos JF, Stelfox HT. Critical care transition programs and the risk of readmission or death after discharge from an ICU: a systematic review and meta-analysis. Crit Care Med. 2014;42(1):179-87.
31. Sobotka SA, Hird-McCorry LP, Goodman DM. Identification of Fail Points for Discharging Pediatric Patients With New Tracheostomy and Ventilator. Hosp Pediatr. 2016;6(9):552-7.
32. Edwards JD, Lucas AR, Stone PW, Boscardin WJ, Dudley RA. Frequency, risk factors, and outcomes of early unplanned readmissions to PICUs. Crit Care Med. 2013;41(12):2773-83.
33. Moffett BS, Humlicek TJ, Rossano JW, Price JF, Cabrera AG. Readmissions for Heart Failure in Children. J Pediatr. 2016;177:153-8 e3.
34. Cuthbertson BH, Rattray J, Campbell MK, Gager M, Roughton S, Smith A, et al. The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial. BMJ. 2009;339:b3723.
35. Jensen JF, Egerod I, Bestle MH, Christensen DF, Elklit A, Hansen RL, et al. A recovery program to improve quality of life, sense of coherence and psychological health in ICU survivors: a multicenter randomized controlled trial, the RAPIT study. Intensive Care Med. 2016;42(11):1733-43.
36. Schofield-Robinson OJ, Lewis SR, Smith AF, McPeake J, Alderson P. Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors. Cochrane Database Syst Rev. 2018;11:CD012701.
2. Ilan R, LeBaron CD, Christianson MK, Heyland DK, Day A, Cohen MD. Handover patterns: an observational study of critical care physicians. BMC Health Serv Res. 2012;12:11.
3. Brenner M, Kidston C, Hilliard C, Coyne I, Eustace-Cook J, Doyle C, et al. Children's complex care needs: a systematic concept analysis of multidisciplinary language. Eur J Pediatr. 2018;177(11):1641-52.
4. Zimmerman JJ, Banks R, Berg RA, Zuppa A, Newth CJ, Wessel D, et al. Critical Illness Factors Associated With Long-Term Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock. Crit Care Med. 2020;48(3):319-28.
5. Wood D, McShane P, Davis P. Tracheostomy in children admitted to paediatric intensive care. Arch Dis Child. 2012;97(10):866-9.
6. Fraser LK, Fleming T, Miller M, Draper ES, McKinney PA, Parslow RC, et al. Palliative care discharge from paediatric intensive care units in Great Britain. Palliat Med. 2010;24(6):608-15.
7. Harris J, Ramelet AS, van Dijk M, Pokorna P, Wielenga J, Tume L, et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals. Intensive Care Med. 2016;42(6):972-86.
8. Chiu AW, Contreras S, Mehta S, Korman J, Perreault MM, Williamson DR, et al. Iatrogenic Opioid Withdrawal in Critically Ill Patients: A Review of Assessment Tools and Management. Ann Pharmacother. 2017;51(12):1099-111.
9. Amigoni A, Mondardini MC, Vittadello I, Zaglia F, Rossetti E, Vitale F, et al. Withdrawal Assessment Tool-1 Monitoring in PICU: A Multicenter Study on Iatrogenic Withdrawal Syndrome. Pediatr Crit Care Med. 2017;18(2):e86-e91.
10. Vipond JM, Heiberger AL, Thompson PA, Huber JN. Shortened Taper Duration after Implementation of a Standardized Protocol for Iatrogenic Benzodiazepine and Opioid Withdrawal in Pediatric Patients: Results of a Cohort Study. Pediatr Qual Saf. 2018;3(3):e079.
11. Sanavia E, Mencia S, Lafever SN, Solana MJ, Garcia M, Lopez-Herce J. Sedative and Analgesic Drug Rotation Protocol in Critically Ill Children With Prolonged Sedation: Evaluation of Implementation and Efficacy to Reduce Withdrawal Syndrome. Pediatr Crit Care Med. 2019;20(12):1111-7.
12. Joint Commission on Accreditation of Healthcare Organizations U. Using medication reconciliation to prevent errors. Sentinel Event Alert. 2006(35):1-4.
13. Bosma LBE, Hunfeld NGM, Quax RAM, Meuwese E, Melief P, van Bommel J, et al. The effect of a medication reconciliation program in two intensive care units in the Netherlands: a prospective intervention study with a before and after design. Ann Intensive Care. 2018;8(1):19.
14. Brenner M, Alexander D, Quirke MB, Eustace-Cook J, Leroy P, Berry J, et al. A systematic concept analysis of 'technology dependent': challenging the terminology. Eur J Pediatr. 2021;180(1):1-12.
15. Brenner M, O'Shea MP, Larkin P, Berry J. Key constituents for integration of care for children assisted with long-term home ventilation: a European study. BMC Pediatr. 2020;20(1):71.
16. Hartman AG, Terhorst L, Little N, Bendixen RM. Uncovering sleep in young males with Duchenne muscular dystrophy. Eur J Paediatr Neurol. 2020;26:20-8.
17. Statile AM, Schondelmeyer AC, Thomson JE, Brower LH, Davis B, Redel J, et al. Improving Discharge Efficiency in Medically Complex Pediatric Patients. Pediatrics. 2016;138(2).
18. Weller J, Boyd M, Cumin D. Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgrad Med J. 2014;90(1061):149-54.
19. Manthous C, Nembhard IM, Hollingshead AB. Building effective critical care teams. Crit Care. 2011;15(4):307.
20. Prince E, Gerstenblith TA, Davydow D, Bienvenu OJ. Psychiatric Morbidity After Critical Illness. Crit Care Clin. 2018;34(4):599-608.
21. Parker AM, Bienvenu OJ. Posttraumatic stress disorder symptoms among family decision makers and the potential relevance of study attrition. Crit Care Med. 2015;43(6):1334-5.
22. Whiting M. Impact, meaning and need for help and support: The experience of parents caring for children with disabilities, life-limiting/life-threatening illness or technology dependence. J Child Health Care. 2013;17(1):92-108.
23. Caffin CL, Linton S, Pellegrini J. Introduction of a liaison nurse role in a tertiary paediatric ICU. Intensive Crit Care Nurs. 2007;23(4):226-33.
24. Ekim A. The Post-Intensive Care Syndrome in Children. Compr Child Adolesc Nurs. 2020;43(1):15-21.
25. Lee M, Kang J, Jeong YJ. Risk factors for post-intensive care syndrome: A systematic review and meta-analysis. Aust Crit Care. 2020;33(3):287-94.
26. Watson RS, Choong K, Colville G, Crow S, Dervan LA, Hopkins RO, et al. Life after Critical Illness in Children-Toward an Understanding of Pediatric Post-intensive Care Syndrome. J Pediatr. 2018;198:16-24.
27. Sobotka SA, Dholakia A, Berry JG, Brenner M, Graham RJ, Goodman DM, et al. Home nursing for children with home mechanical ventilation in the United States: Key informant perspectives. Pediatr Pulmonol. 2020;55(12):3465-76.
28. Munoz-Bonet JI, Lopez-Prats JL, Flor-Macian EM, Cantavella T, Bonet L, Dominguez A, et al. Usefulness of telemedicine for home ventilator-dependent children. J Telemed Telecare. 2020;26(4):207-15.
29. Lynch J, Cope V, Murray M. The Intensive Care Unit Liaison Nurse and their value in averting clinical deterioration: A qualitative descriptive study. Intensive Crit Care Nurs. 2020:103001.
30. Niven DJ, Bastos JF, Stelfox HT. Critical care transition programs and the risk of readmission or death after discharge from an ICU: a systematic review and meta-analysis. Crit Care Med. 2014;42(1):179-87.
31. Sobotka SA, Hird-McCorry LP, Goodman DM. Identification of Fail Points for Discharging Pediatric Patients With New Tracheostomy and Ventilator. Hosp Pediatr. 2016;6(9):552-7.
32. Edwards JD, Lucas AR, Stone PW, Boscardin WJ, Dudley RA. Frequency, risk factors, and outcomes of early unplanned readmissions to PICUs. Crit Care Med. 2013;41(12):2773-83.
33. Moffett BS, Humlicek TJ, Rossano JW, Price JF, Cabrera AG. Readmissions for Heart Failure in Children. J Pediatr. 2016;177:153-8 e3.
34. Cuthbertson BH, Rattray J, Campbell MK, Gager M, Roughton S, Smith A, et al. The PRaCTICaL study of nurse led, intensive care follow-up programmes for improving long term outcomes from critical illness: a pragmatic randomised controlled trial. BMJ. 2009;339:b3723.
35. Jensen JF, Egerod I, Bestle MH, Christensen DF, Elklit A, Hansen RL, et al. A recovery program to improve quality of life, sense of coherence and psychological health in ICU survivors: a multicenter randomized controlled trial, the RAPIT study. Intensive Care Med. 2016;42(11):1733-43.
36. Schofield-Robinson OJ, Lewis SR, Smith AF, McPeake J, Alderson P. Follow-up services for improving long-term outcomes in intensive care unit (ICU) survivors. Cochrane Database Syst Rev. 2018;11:CD012701.