A specialized multi-disciplinary care program for children with sepsis and multiple organ dysfunction-associated immune dysregulation

Abstract

The complex physiology and medical requirements of children with sepsis and multiple organ dysfunction syndrome (MODS) challenge traditional care coordination models. While the involvement of multiple clinical subspecialty services is often necessary to support different care processes and individual organ system dysfunctions, it can also delay the diagnostic process, monitoring, and treatment. The logistics of coordinating with many specialty providers for critically ill patients are challenging and time consuming, and often can result in fragmented communication. To address these and other related issues, we developed a new multi-disciplinary consult service focused on streamlining diagnostics, management, and communication for patients with sepsis and MODS-associated immune dysregulation. The service, called the Program in Inflammation, Immunity, and the Microbiome (PrIIMe), is now a hospital-wide clinical consult service at our institution caring for a broad group of patients with immune dysregulation, particularly focusing on patients with sepsis and MODS. In this paper, we summarize the development, structure, and function of the program, as well as the initial impact. This information may be helpful to clinicians and healthcare leaders who are developing multi-disciplinary consult services for children with complex care needs, especially those with sepsis and MODS-associated immune dysregulation. Impact The care of children with sepsis and multiple organ dysfunction-associated immune dysregulation requires rapid and flexible involvement of multiple clinical subspecialists that is difficult to achieve without fragmented care and delayed decision making. In this narrative review we describe the development, structure, and function of a multi-disciplinary consult service at a children’s hospital dedicated to helping coordinate management and provide continuity of care for patients with sepsis and multiple organ dysfunction-associated immune dysregulation. This information may be helpful to clinicians and healthcare leaders who are developing multi-disciplinary consult services for children with complex care needs, especially those with sepsis and MODS-associated immune dysregulation.

Psychosocial functioning in individuals with advanced oesophago-gastric cancer: a mixed methods systematic review

“…In particular, the logistics of navigating multi-disciplinary care were often felt to be challenging and frustrating, with fractured communication between departments, an inability to establishing lasting therapeutic relationships and a lack of support for medication adherence appearing to influence the patient’s psychosocial functioning. Similar findings have been identified in patients with complex needs [ 88 ] and children with sepsis and multiple organ dysfunction-associated immune dysregulation [ 89 ]Whilst evidence from the qualitative studies reported several unmet healthcare needs in this clinical population, no quantitative findings could confirm these findings. In light of the multitude of healthcare challenges outlined throughout this review, future research should seek to obtain insight into the care provided to individuals with advanced oesophago-gastric cancer, in relation to the reported unmet care needs and satisfaction with the care provided.…”

Peculiarities of therapeutic tactics in neonatal sepsis depending on the body's inflammatory response

“…Отже, комплексне лікування хворих на сепсис немовлят потребує, з одного боку, ін-дивідуалізованого підходу і менеджменту з урахуванням біомаркерів, а з іншого -міждисциплінарного комплексного бачення проблем поліорганної невідповідності [21], у тому числі синдромів гіперзапалення, тяжкого мультисистемного запального синдрому з індивідуальним лікуванням цих складних розладів.…”

Dr. Degar et al reply

“…Swigart et al recently reported on the successful development of a multidisciplinary, inpatient consult service for children with sepsis and multiorgan dysfunction syndrome. 10 During the coronavirus disease 2019 (COVID-19) pandemic, many pediatric institutions developed a similar multisubspecialty approach to the management of children with multisystem inflammatory syndrome. The development, structure, and scope of these types of collaborative and multidisciplinary teams vary across institutions.…”