Christina L Cifra1, Kimberly C Dukes2, Brennan S Ayres3, Kelsey A Calomino4, Loreen A Herwaldt5, Hardeep Singh6, Heather Schacht Reisinger7. 1. Division of Pediatric Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, 200 Hawkins Dr 8600-M JCP, Iowa City, IA 52242, USA. Electronic address: christina-cifra@uiowa.edu. 2. Institute for Clinical and Translational Science, University of Iowa 200 Hawkins Dr, Iowa City, IA 52242, USA; Iowa City Veterans Affairs Health Care System, 601 US-6 W Suite 42-1 VAMC, Iowa City, IA 52246, USA. Electronic address: kimberly-dukes@uiowa.edu. 3. Department of Industrial and Systems Engineering, University of Iowa College of Engineering 3100 Seamans Center for the Engineering Arts and Sciences, Iowa City, IA 52242, USA; Touro College of Osteopathic Medicine (present address), 230 W 125(th) St, New York, NY 10027, USA. 4. University of Iowa College of Nursing, 50 Newton Rd, Iowa City, IA 52242, USA. Electronic address: kelsey-calomino@uiowa.edu. 5. Department of Internal Medicine, University of Iowa Carver College of Medicine 200 Hawkins Dr, Iowa City, IA 52242, USA; Department of Epidemiology, University of Iowa College of Public Health 145 N Riverside Dr, Iowa City, IA 52242, USA. Electronic address: loreen-herwaldt@uiowa.edu. 6. Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey eterans Affairs Medical Center and Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: hardeeps@bcm.edu. 7. Institute for Clinical and Translational Science, University of Iowa 200 Hawkins Dr, Iowa City, IA 52242, USA; Department of Internal Medicine, University of Iowa Carver College of Medicine 200 Hawkins Dr, Iowa City, IA 52242, USA; Iowa City Veterans Affairs Health Care System, 601 US-6 W Suite 42-1 VAMC, Iowa City, IA 52246, USA. Electronic address: heather-reisinger@uiowa.edu.
Abstract
PURPOSE: The effect of communication between referring and accepting clinicians during patient transitions to the pediatric intensive care unit (PICU) on diagnostic quality is largely unknown. This pilot study aims to determine the feasibility of using focused ethnography to understand the relationship between referral communication and the diagnostic process for critically ill children. MATERIALS AND METHODS: We conducted focused ethnography in an academic tertiary referral PICU by directly observing the referral and admission of 3 non-electively admitted children 0-17 years old. We also conducted 21 semi-structured interviews of their parents and admitting PICU staff (intensivists, fellows/residents, medical students, nurses, and respiratory therapists) and reviewed their medical records post-discharge. RESULTS: Performing focused ethnography in a busy PICU is feasible. We identified three areas for additional exploration: (1) how information transfer affects the PICU diagnostic process; (2) how uncertainty in patient assessment affects the decision to transfer to the PICU; and (3) how the PICU team's expectations are influenced by referral communication. CONCLUSIONS: Focused ethnography in the PICU is feasible to investigate relationships between clinician referral communication and the diagnostic process for critically ill children.
PURPOSE: The effect of communication between referring and accepting clinicians during patient transitions to the pediatric intensive care unit (PICU) on diagnostic quality is largely unknown. This pilot study aims to determine the feasibility of using focused ethnography to understand the relationship between referral communication and the diagnostic process for critically ill children. MATERIALS AND METHODS: We conducted focused ethnography in an academic tertiary referral PICU by directly observing the referral and admission of 3 non-electively admitted children 0-17 years old. We also conducted 21 semi-structured interviews of their parents and admitting PICU staff (intensivists, fellows/residents, medical students, nurses, and respiratory therapists) and reviewed their medical records post-discharge. RESULTS: Performing focused ethnography in a busy PICU is feasible. We identified three areas for additional exploration: (1) how information transfer affects the PICU diagnostic process; (2) how uncertainty in patient assessment affects the decision to transfer to the PICU; and (3) how the PICU team's expectations are influenced by referral communication. CONCLUSIONS: Focused ethnography in the PICU is feasible to investigate relationships between clinician referral communication and the diagnostic process for critically ill children.
Authors: Trisha Greenhalgh; Ellen Annandale; Richard Ashcroft; James Barlow; Nick Black; Alan Bleakley; Ruth Boaden; Jeffrey Braithwaite; Nicky Britten; Franco Carnevale; Kath Checkland; Julianne Cheek; Alex Clark; Simon Cohn; Jack Coulehan; Benjamin Crabtree; Steven Cummins; Frank Davidoff; Huw Davies; Robert Dingwall; Mary Dixon-Woods; Glyn Elwyn; Eivind Engebretsen; Ewan Ferlie; Naomi Fulop; John Gabbay; Marie-Pierre Gagnon; Dariusz Galasinski; Ruth Garside; Lucy Gilson; Peter Griffiths; Penny Hawe; Jan-Kees Helderman; Brian Hodges; David Hunter; Margaret Kearney; Celia Kitzinger; Jenny Kitzinger; Ayelet Kuper; Saville Kushner; Andree Le May; France Legare; Lorelei Lingard; Louise Locock; Jill Maben; Mary Ellen Macdonald; Frances Mair; Russell Mannion; Martin Marshall; Carl May; Nicholas Mays; Lorna McKee; Marissa Miraldo; David Morgan; Janice Morse; Sarah Nettleton; Sandy Oliver; Warrren Pearce; Pierre Pluye; Catherine Pope; Glenn Robert; Celia Roberts; Stefania Rodella; Jo Rycroft-Malone; Margarete Sandelowski; Paul Shekelle; Fiona Stevenson; Sharon Straus; Deborah Swinglehurst; Sally Thorne; Göran Tomson; Gerd Westert; Sue Wilkinson; Brian Williams; Terry Young; Sue Ziebland Journal: BMJ Date: 2016-02-10
Authors: Christina L Cifra; Kareen L Jones; Judith A Ascenzi; Utpal S Bhalala; Melania M Bembea; David E Newman-Toker; James C Fackler; Marlene R Miller Journal: Pediatr Crit Care Med Date: 2015-06 Impact factor: 3.624
Authors: Colleen K McIlvennan; Megan A Morris; Timothy C Guetterman; Daniel D Matlock; Leslie Curry Journal: Circ Cardiovasc Qual Outcomes Date: 2019-09-12
Authors: Jason W Custer; Elizabeth White; James C Fackler; Yan Xiao; Allen Tien; Harold Lehmann; David G Nichols Journal: Pediatr Crit Care Med Date: 2012-05 Impact factor: 3.624
Authors: Christina L Cifra; Patrick Ten Eyck; Jeffrey D Dawson; Heather Schacht Reisinger; Hardeep Singh; Loreen A Herwaldt Journal: Pediatr Crit Care Med Date: 2020-05 Impact factor: 3.624