Feature Articles

Primary Intensivists and Nurses for Long-Stay Patients: A Survey of Practices and Perceptions at Academic PICUs*

Williams, Erin P. MD MBE^1,2; Madrigal, Vanessa N. MD, MSCE^3,4; Leone, Tina A. MD⁵; Aponte-Patel, Linda MD⁶; Baird, Jennifer D. PhD, MPH, MSW, RN⁷; Edwards, Jeffrey D. MD, MA, MAS⁶

Author Information

¹ Cohen Children’s Medical Center, Northwell Health, New Hyde Park, NY.

² Columbia University Vagelos College of Physician and Surgeons, New York, NY.

³ Division of Critical Care Medicine, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC.

⁴ Pediatric Ethics Program, Children’s National Medical Center, Washington, DC.

⁵ Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Columbia University Vagelos College of Physician and Surgeons, New York, NY.

⁶ Section of Critical Care, Department of Pediatrics, Columbia University Vagelos College of Physician and Surgeons, New York, NY.

⁷ Institute for Nursing and Interprofessional Research, Children’s Hospital Los Angeles, Los Angeles, CA.

*See also p. 512.

Dr. Williams conceptualized the study, performed data curation, investigation, and analysis, and drafted the manuscript. Dr. Madrigal contributed to study conceptualization and methodology and critically reviewed/edited the manuscript. Dr. Leone contributed to study conceptualization, investigation, and critically reviewed/edited the manuscript. Dr. Aponte-Patel contributed to study conceptualization, investigation, and critically reviewed/edited the manuscript. Prof. Baird contributed to study conceptualization and methodology, provided supervision, and critically reviewed/edited the manuscript. Dr. Edwards conceptualized and designed the methodology, performed investigation, performed data curation, drafted the manuscript, and supervised all aspects of study conduct and analyses.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Dr. Aponte-Patel received funding from the Columbia University Department of Psychiatry and NYP Weill Cornell. Dr. Baird received funding from I-PASS Patient Safety Institute. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: [email protected]

Pediatric Critical Care Medicine 24(6):p 436-446, June 2023. | DOI: 10.1097/PCC.0000000000003181

Abstract

Objectives:

To determine the prevalence of the utilization of primary intensivists and primary nurses for long-stay patients in large, academic PICU and ascertain how these practices are operationalized and perceived.

Design:

A cross-sectional survey.

Setting:

U.S. PICUs with accredited Pediatric Critical Care Medicine fellowships.

Subjects:

One senior physician and one senior nurse at each institution.

Intervention:

None.

Measurements and Main Results:

Separate but largely analogous questionnaires for intensivists and nurses were created using an iterative process to enhance content/face validity and readability. Sixty-seven intensivists (representing 93% of the 72 institutions with fellowship programs and their PICUs) and 59 nurses (representing 82%) responded. Twenty-four institutions utilize primary intensivists; 30 utilize primary nurses; and 13 utilize both. Most institutions use length of stay and/or other criteria (e.g., medical complexity) for eligibility. Commonly, not all patients that meet eligibility criteria receive primaries. Primary providers are overwhelmingly volunteers, and often only a fraction of providers participate. Primary intensivists at a large majority (>75%) of institutions facilitate information sharing and decision-making, attend family/team meetings, visit patients/families regularly, and are otherwise available upon request. Primary nurses at a similar majority of institutions provide consistent bedside care, facilitate information sharing, and attend family/team meetings. A large majority of respondents thought that primary intensivists increase patient/family satisfaction, reduce their stress, improve provider communication, and reduce conflict, whereas primary nurses similarly increase patient/family satisfaction. More than half of respondents shared that these practices can sometimes require effort (e.g., time and emotion), complicate decision-making, and/or reduce staffing flexibility.

Conclusions:

Primary practices are potential strategies to augment rotating PICU care models and better serve the needs of long-stay and other patients. These practices are being utilized to varying extents and with some operationalization uniformity at large, academic PICUs.

Article Keywords

Keywords
child, continuity of patient care, intensive care units, pediatric, long-term care, models, nursing, practice patterns, physician’s

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Primary Intensivists and Nurses for Long-Stay Patients: A Survey of Practices and Perceptions at Academic PICUs*