title: The factors associated with high-quality communication for critically ill children.
abstract: OBJECTIVE
  Timely, high quality communication with families is essential to family-centered decision-making. Quality communication is represented by widespread documentation of prognostic, goals-of-care conversations (PGOCC) in the pediatric intensive care unit (PICU) and should occur without variation by patient characteristics.
  
  
  METHODS
  Cohort included 645 PICU admissions in the top decile of risk of mortality on admission over six years. Electronic medical records were used to determine PGOCC, diagnosis on admission and complex chronic condition (CCC) status. Multivariate logistic regression and time-to-event analyses were used.
  
  
  RESULTS
  Overall, 31% had a documented PGOCC. 51% had CCC status. 11% had an oncologic, 13% had a cardiovascular diagnosis on admission. 94% of patients who died in the PICU had PGOCC documented, but among the 200 patients with documented PGOCC, 78% did not die in the PICU. Oncologic diagnosis on admission was associated with a higher likelihood of PGOCC compared to non-CCC patients (ARR=1.86; SE=0.26) whereas no other diagnosis category reached the level of statistical significance. Median time from admission to PGOCC was 2 days. Age, gender and CCC status were not associated with whether a PGOCC was documented or with time from admission to PGOCC documentation. 45% of PGOCC in the cohort and 50% of conversations in patients with CCC were documented by PICU physicians.
  
  
  CONCLUSIONS
  This study reveals the opportunity for improvement in documentation of PGOCC for critically ill children. It raises the questions of why there is variation of PGOCC across disease categories and whether PGOCC should be considered a quality measure for family-centered care.
authors: Division of General Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 3535 Market St., Philadelphia, PA 19104, USA. walterj1@email.chop.edu
authors: Jennifer K
authors: JK
authors: Walter
authors: Brian D
authors: BD
authors: Benneyworth
authors: Michelle
authors: M
authors: Housey
authors: Matthew M
authors: MM
authors: Davis
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003142:Communication; D016638:Critical Illness; D004282:Documentation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D008824:Michigan; D015999:Multivariate Analysis; D009369:Neoplasms / Q000453:epidemiology; D010347:Patient Care Planning; D011368:Professional-Family Relations; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult