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This proof-of-concept study indicates that remote parent participation in PICU rounds is feasible, enhances parent-provider communication, and offers parents reassurance. Providers reported a high level of satisfaction with minimal disruption. Technological advancements to streamline teleconferencing workflow are needed to ensure program sustainability.

Future research and work need to be focused on standards and guidelines on implementing an EHR that encompasses all age contexts.

Importance Pediatric laryngotracheal reconstruction (LTR) remains the standard surgical technique for expanding a stenotic airway and necessitates a multidisciplinary team. Sedation wean following LTR is a critical component of perioperative care. We identified variation and communications deficiencies with our sedation wean practice and describe our experience implementing a standardized sedation wean protocol. Objective Standardize and decrease length of sedation wean in pediatric patients undergoing LTR. Design Using Institute for Healthcare Improvement (IHI) methodology, we implemented system-wide change with the goal of improving care based on best practice guidelines. We created a standardized electronic sedation wean communication document and retrospectively examined our experience in 29 consecutive patients who underwent LTR before (n=16, pre-wean group) and after (n=13, post-wean group) wean document implementation. Setting Tertiary care center Participants Pediatric patients undergoing LTR Intervention Implement standardized sedation protocol Main Outcomes Presence of sedation wean document in electronic medical record, length of sedation wean, and need for continued wean after discharge Results The sedation wean document was utilized in 92.3% patients of the post-wean group. With the new process, the mean length of sedation wean was reduced from 16.19 (standard deviation [SD] 11.56) days in pre-wean group to 8.92 (SD 3.37) days in the post-wean group, p<0.05. Fewer patients in the post-wean group required continued wean after discharge, 81.3% vs. 33.3%, p<0.05. Conclusions and Relevance We implemented system-wide process change with the goal of improving care based on best practice guidelines, which significantly decreased the time required for sedation wean following LTR. Our methodological approach may have implications for other heterogeneous patient populations requiring a sedation wean.

Mild potassium abnormalities are common in the PICU. Repeating hemolyzed hyperkalemic samples may be beneficial. Guidance in monitoring frequencies of potassium abnormalities in pediatric critical care is needed.

Background Organ donation after cardiac death is increasingly implemented, with outcomes similar to those of organ donation after brain death. Many hospitals hesitate to implement a protocol for donation after cardiac death because of the potential negative reactions among health care providers. Objectives To determine the acceptance of a protocol for donation after cardiac death among multidisciplinary staff in a pediatric intensive care unit. Methods An anonymous, 15-question, Likert-scale questionnaire (scores 1–5) was used to determine the opinions of staff about donation after brain death and after cardiac death in a pediatric intensive care unit of a tertiary-care university hospital. Results Survey response rate was 67% (n = 60). All physicians, 89% of nurses, and 82% of the remaining staff members stated that they understood the difference between donation after brain death and donation after cardiac death; staff supported both types of donation, at rates of 90% and 85%, respectively. Staff perception was the same for each type of donation (ρ = 0.82; r = 0.92; P &lt; .001). The 20 staff members who provided care directly to patients who were donors after cardiac death considered such donation worthwhile. However, 60% of those providers offered suggestions to improve the established protocol for donation. Conclusions The multidisciplinary staff has accepted organ donation after cardiac death and has fully integrated this kind of donation without reported differences from their acceptance of donation after brain death.

PICU hospitalization results in a range of direct NMOOPEs of varying burden on families and additional work productivity impact. Further research to understand the array of financial implications on families and additional mitigation strategies are needed.