Does ICU Structure Impact Patient Outcomes After Congenital Heart Surgery? A Critical Appraisal of “Care Models and Associated Outcomes in Congenital Heart Surgery” by Burstein et al (Pediatrics 2011; 127

Hilvers, Pamela; Thammasitboon, Satid

doi:10.1097/pcc.0000000000000012

Cited by 4 publications

(2 citation statements)

References 24 publications

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“…The higher expertise in cardiac care through cardiologists and cardiac surgeons may be compensated with better team management and higher competence in general pediatric intensive care through pediatric intensivists. 64 Regarding team composition, there is a growing plea by patient organizations, supported by medical literature, that the patient or relatives should be empowered, encouraged, and trusted as being part of the caring team. 65 , 66 Parents of a sick child in a PICU are the only persistent team members; they have the highest interest in a good outcome; and they are the primary source of information.…”

Section: Challenges and Findingsmentioning

confidence: 99%

Interprofessional team management in pediatric critical care: some challenges and possible solutions

Stocker

Pilgrim²,

Burmester³

et al. 2016

JMDH

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© 2016 Stocker et al.Background: Aiming for and ensuring effective patient safety is a major priority in the management and culture of every health care organization. The pediatric intensive care unit (PICU) has become a workplace with a high diversity of multidisciplinary physicians and professionals. Therefore, delivery of high-quality care with optimal patient safety in a PICU is dependent on effective interprofessional team management. Nevertheless, ineffective interprofessional teamwork remains ubiquitous. Methods: We based our review on the framework for interprofessional teamwork recently published in association with the UK Centre for Advancement of Interprofessional Education. Articles were selected to achieve better understanding and to include and translate new ideas and concepts. Findings: The barrier between autonomous nurses and doctors in the PICU within their silos of specialization, the failure of shared mental models, a culture of disrespect, and the lack of empowering parents as team members preclude interprofessional team management and patient safety. A mindset of individual responsibility and accountability embedded in a network of equivalent partners, including the patient and their family members, is required to achieve optimal interprofessional care. Second, working competently as an interprofessional team is a learning process. Working declared as a learning process, psychological safety, and speaking up are pivotal factors to learning in daily practice. Finally, changes in small steps at the level of the microlevel unit are the bases to improve interprofessional team management and patient safety. Once small things with potential impact can be changed in one’s own unit, engagement of health care professionals occurs and projects become accepted. Conclusion: Bottom–up patient safety initiatives encouraging participation of every single care provider by learning effective interprofessional team management within daily practice may be an effective way of fostering patient safety

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Section: Challenges and Findingsmentioning

confidence: 99%

Interprofessional team management in pediatric critical care: some challenges and possible solutions

Stocker

Pilgrim²,

Burmester³

et al. 2016

JMDH

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“…3 In general, hospitals with dedicated cardiac ICUs have higher surgical volumes and younger patients with higher-risk defects, increasing fellow exposure to higher acuity patients. 3,17,18 We begin to describe the variability in surgical volume exposure and acuity, as depicted in Figure 1. While data in this figure are based on calculated assumptions, they depict an obvious trend: programmes with more CHD surgical cases do not necessarily provide more learning opportunities per fellow.…”

Section: Discussionmentioning

confidence: 99%

High variability in cardiac education and experiences during United States paediatric critical care fellowships

et al. 2022

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Background: Paediatric cardiac critical care continues to become more sub-specialised, and many institutions have transitioned to dedicated cardiac ICUs. Literature regarding the effects of these changes on paediatric critical care medicine fellowship training is limited. Objective: To describe the current landscape of cardiac critical care education during paediatric critical care medicine fellowship in the United States and demonstrate its variability. Methods: A review of publicly available information in 2021 was completed. A supplemental REDCap survey focusing on cardiac ICU experiences during paediatric critical care medicine fellowships was e-mailed to all United States Accreditation Council of Graduate Medical Education-accredited paediatric critical care medicine fellowship programme coordinators/directors. Results are reported using inferential statistics. Results: Data from 71 paediatric critical care medicine fellowship programme websites and 41 leadership responses were included. Median fellow complement was 8 (interquartile range: 6, 12). The majority (76%, 31/41) of programmes had a designated cardiac ICU. Median percentage of paediatric critical care medicine attending physicians with cardiac training was 25% (interquartile range: 0%, 69%). Mandatory cardiac ICU time was 16 weeks (interquartile range: 13, 20) with variability in night coverage and number of other learners present. A minority of programmes (29%, 12/41) mandated other cardiac experiences. Median CHD surgical cases per year were 215 (interquartile range: 132, 338). When considering the number of annual cases per fellow, programmes with higher case volume were not always associated with the highest case number per fellow. Conclusions: There is a continued trend toward dedicated cardiac ICUs in the United States, with significant variability in cardiac training during paediatric critical care medicine fellowship. As the trend toward dedicated cardiac ICUs continues and practices become more standardised, so should the education.

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Cardiac Intensive Care Unit

Fehr¹,

Welch²

2017

Smith's Anesthesia for Infants and Children

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Does ICU Structure Impact Patient Outcomes After Congenital Heart Surgery? A Critical Appraisal of “Care Models and Associated Outcomes in Congenital Heart Surgery” by Burstein et al (Pediatrics 2011; 127

Abstract: This paper suggests that the composition of the ICU is not a critical factor in determining outcomes after congenital heart surgery. Other factors, such as expertise of the nurses, physicians, and surgeons, as well as technical performance, should be considered.

Cited by 4 publications

References 24 publications

Interprofessional team management in pediatric critical care: some challenges and possible solutions

Interprofessional team management in pediatric critical care: some challenges and possible solutions

High variability in cardiac education and experiences during United States paediatric critical care fellowships

Cardiac Intensive Care Unit

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