Pediatric Ethics and Communication Excellence (PEACE) Rounds: Decreasing Moral Distress and Patient Length of Stay in the PICU

Wocial, Lucia D.; Ackerman, Veda L.; Leland, Brian D.; Benneyworth, Brian D.; Patel, Vinit; Tong, Yan; Nitu, Mara

doi:10.1007/s10730-016-9313-0

Cited by 86 publications

(111 citation statements)

References 39 publications

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“…Any concerns that the group identifies are discussed by the palliative care and ICU teams with the family. 27 When evaluating the itemized charges for our subjects, we found no significant differences between the 2 groups when adjusted per subject day. This finding illustrates that the subjects' inherent medical conditions were not necessarily the key drivers of the overall hospital cost, rather the length of the subjects' stay was more likely the primary contributor.…”

Section: Discussionmentioning

confidence: 71%

Health Care Resource Utilization for Children Requiring Prolonged Mechanical Ventilation via Tracheostomy

et al. 2020

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BACKGROUND: More children are discharged from ICUs on prolonged mechanical ventilation (PMV) via tracheostomy than ever before. These patients have long hospitalizations with high resource expenditure. Our objective was to describe the characteristics of these resource-intensive patients and to evaluate their costs of care. We hypothesized that subjects requiring PMV for neurologic diagnoses would have higher costs, longer hospital length of stay (LOS), and worse outcomes than those with primarily respiratory diagnoses. METHODS: We identified 50 pediatric subjects between January 2015 and December 2017 at our institution who had a new tracheostomy placement and were enrolled in a home mechanical ventilation program. Collected data included demographics, indication for tracheostomy, LOS, hospital costs, readmissions, and outcomes. We also compared subjects who required PMV for respiratory diagnoses versus neurologic diagnoses. RESULTS: Of 50 subjects, 41 were < 12 months old at the time of tracheostomy. Thirty-four subjects had a respiratory diagnosis requiring PMV, 14 had a neurologic diagnosis, and 2 had a cardiac diagnosis. The total initial hospitalization cost was $31,133,582, which averages to $622,671 per subject. The average initial hospitalization LOS was 155 d. Respiratory subjects had longer LOS and higher average costs than neurologic subjects. The average readmission rate was 2.16 per subject in the first year after discharge, and the average readmission cost per subject was $73,144. Eight subjects died in the first year after discharge, and 4 suffered a serious morbidity. CONCLUSIONS: This descriptive study evaluated the social and medical characteristics of subjects being discharged from the pediatric ICU with PMV via tracheostomy, as well as quantified the financial impact of their care. Those requiring PMV for neurologic diagnoses had shorter hospital LOS and lower hospital costs than those with respiratory diagnoses. No definitive differences in outcomes were found.

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Section: Discussionmentioning

confidence: 71%

Health Care Resource Utilization for Children Requiring Prolonged Mechanical Ventilation via Tracheostomy

et al. 2020

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“…Additionally, in order to foster a more interprofessional dialogue on real-time clinical ethical dilemmas, our Center for Bioethics and Health Policy has spearheaded adult and pediatric Bioethics Performance Improvement Teams (BIOPIT) where nurses, physicians, case managers, social workers and other health professionals have a forum to discuss complex healthcare decisions. Other institutions who have developed similar processes have documented decreased moral distress amongst participants [26], and we are currently in the process of studying the effects of the BIOPIT on provider and nursing moral distress. These emerging programs and similar interprofessional efforts will be incorporated into future medical ethics education.…”

Section: Discussionmentioning

confidence: 99%

An interprofessional cohort analysis of student interest in medical ethics education: a survey-based quantitative study

et al. 2020

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Background: There is continued need for enhanced medical ethics education across the United States. In an effort to guide medical ethics education reform, we report the first interprofessional survey of a cohort of graduate medical, nursing and allied health professional students that examined perceived student need for more formalized medical ethics education and assessed preferences for teaching methods in a graduate level medical ethics curriculum. Methods: In January 2018, following the successful implementation of a peer-led, grassroots medical ethics curriculum, student leaders under faculty guidance conducted a cross-sectional survey with 562 of 1357 responses received (41% overall response rate) among students enrolled in the School of Medicine, College of Nursing, Doctor of Physical Therapy and BS/(D) MD Professional Scholars programs at The Medical College of Georgia at Augusta University. An in person or web-based questionnaire was designed to measure perceived need for a more in-depth medical ethics curriculum. Results: The majority of respondents were female (333, 59.3%), white (326, 58.0%) and mid-20s in age (340, 60.5%). Almost half of respondents (47%) reported no prior medical ethics exposure or training in their previous educational experience, while 60% of students across all degree programs reported an interest in more medical ethics education and 92% noted that an understanding of medical ethics was important to their future career. Over a quarter of students (28%) were interested in pursuing graduate-level training in medical ethics, with case-based discussions, small group peer settings and ethics guest lectures being the most desired teaching methods. Conclusions: The future physician, nursing and physical therapist workforce in our medical community demonstrated an unmet need and strong interest for more formal medical ethics education within their current coursework. Grassroots student-driven curricular development and leadership in medical ethics can positively impact medical education. Subsequent integration of interprofessional training in medical ethics may serve as a vital curricular approach to improving the training of ethically competent healthcare professionals and overcoming the current hierarchical clinical silos.

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“…However, the limited time allotted in traditional education curricula leave the content and delivery format of medical ethics education across disciplines open for debate [18][19][20]. As educators, we are challenged by the significant variation and lack of succinct goals and outcomes in medical ethics teaching methods across institutions nationwide [11, 22- [26], and we are currently in the process of studying the effects of the BIOPIT on provider and nursing moral distress. These emerging programs and similar interprofessional efforts will be incorporated into future medical ethics education.…”

Section: Discussionmentioning

confidence: 99%

An interprofessional cohort analysis of student interest in medical ethics education: A survey-based quantitative study

DeFoor

Chung

Zadinsky

et al. 2019

Preprint

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Background: There is continued need for enhanced medical ethics education across the United States. In an effort to guide medical ethics education reform, we report the first interprofessional survey of a cohort of graduate medical, nursing and allied health professional students that examined perceived student need for more formalized medical ethics education and assessed preferences for teaching methods in a graduate level medical ethics curriculum. Methods: In January 2018, following the successful implementation of a peer-led, grassroots medical ethics curriculum, student leaders under faculty guidance conducted a cross-sectional survey with 562 of 1,357 responses received (41% overall response rate) among students enrolled in the School of Medicine, College of Nursing, Doctor of Physical Therapy and BS/(D)MD Professional Scholars programs at the [Name of institution blinded for review]. An in person or web-based questionnaire was designed to measure perceived need for a more in-depth medical ethics curriculum. Results: The majority of respondents were female (333, 59.3%), white (326, 58.0%) and mid-20s in age (340, 60.5%). Almost half of respondents (47%) reported no prior medical ethics exposure or training in their previous educational experience, while 60% of students across all degree programs reported an interest in more medical ethics education and 92% noted that an understanding of medical ethics was important to their future career. Over a quarter of students (28%) were interested in pursuing graduate-level training in medical ethics, with case-based discussions, small group peer settings and ethics guest lectures being the most desired teaching methods. Conclusions: The future physician, nursing and physical therapist workforce in our medical community demonstrated an unmet need and strong interest for more formal medical ethics education within their current coursework. Grassroots student-driven curricular development and leadership in medical ethics can positively impact medical education. Subsequent integration of interprofessional training in medical ethics may serve as a vital curricular approach to improving the training of ethically competent healthcare professionals and overcoming the current hierarchical clinical silos.

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Pediatric Ethics and Communication Excellence (PEACE) Rounds: Decreasing Moral Distress and Patient Length of Stay in the PICU

Cited by 86 publications

References 39 publications

Health Care Resource Utilization for Children Requiring Prolonged Mechanical Ventilation via Tracheostomy

Health Care Resource Utilization for Children Requiring Prolonged Mechanical Ventilation via Tracheostomy

An interprofessional cohort analysis of student interest in medical ethics education: a survey-based quantitative study

An interprofessional cohort analysis of student interest in medical ethics education: A survey-based quantitative study

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