title: Examining palliative care team involvement in automatic consultations for children on extracorporeal life support in the pediatric intensive care unit.
abstract: BACKGROUND
  Extracorporeal life support (ECLS) is an advanced form of life-sustaining therapy that creates stressful dilemmas for families. In May 2009, Seattle Children's Hospital (SCH) implemented a policy to involve the Pediatric Advanced Care Team (PACT) in all ECLS cases through automatic referral.
  
  
  OBJECTIVE
  Our aim was to describe PACT involvement in the context of automatic consultations for ECLS patients and their family members.
  
  
  METHODS
  We retrospectively examined chart notes for 59 consecutive cases and used content analysis to identify themes and patterns.
  
  
  RESULTS
  The degree of PACT involvement was related to three domains: prognostic uncertainty, medical complexity, and need for coordination of care with other services. Low PACT involvement was associated with cases with little prognostic uncertainty, little medical complexity, and minimal need for coordination of care. Medium PACT involvement was associated with two categories of cases: 1) those with a degree of medical complexity but little prognostic uncertainty; and 2) those that had a degree of prognostic uncertainty but little medical complexity. High PACT involvement had the greatest medical complexity and prognostic uncertainty, and also had those cases with a high need for coordination of care.
  
  
  CONCLUSIONS
  We describe a framework for understanding the potential involvement of palliative care among patients receiving ECLS that explains how PACT organizes its efforts toward patients and families with the highest degree of need. Future studies should examine whether this approach is associated with improved patient and family outcomes.
authors.affiliation: Department of Biobehavioral Nursing and Health Systems, School of Nursing, University of Washington, Seattle, WA 98195, USA. doorenbo@uw.edu
authors.forename: Ardith Z
authors.initials: AZ
authors.lastname: Doorenbos
authors.forename: Helene
authors.initials: H
authors.lastname: Starks
authors.forename: Erica
authors.initials: E
authors.lastname: Bourget
authors.forename: D Michael
authors.initials: DM
authors.lastname: McMullan
authors.forename: Mithya
authors.initials: M
authors.lastname: Lewis-Newby
authors.forename: Tessa C
authors.initials: TC
authors.lastname: Rue
authors.forename: Taryn
authors.initials: T
authors.lastname: Lindhorst
authors.forename: Eugene
authors.initials: E
authors.lastname: Aisenberg
authors.forename: Natalie
authors.initials: N
authors.lastname: Oman
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.forename: Ross
authors.initials: R
authors.lastname: Hays
authors.forename: Jonna D
authors.initials: JD
authors.lastname: Clark
authors.forename: Harris P
authors.initials: HP
authors.lastname: Baden
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Brogan
authors.forename: Jane L
authors.initials: JL
authors.lastname: Di Gennaro
authors.forename: Robert
authors.initials: R
authors.lastname: Mazor
authors.forename: Joan S
authors.initials: JS
authors.lastname: Roberts
authors.forename: Jessica
authors.initials: J
authors.lastname: Turnbull
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Wilfond
mesh_terms: D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D010166:Palliative Care; D010348:Patient Care Team / Q000458:organization & administration*; D011379:Prognosis; D012189:Retrospective Studies
references.citation: J Hosp Palliat Nurs. 2011 Mar;13(2):89-94
references.pmid: 21874122
references.citation: BMC Pulm Med. 2011 Jan 11;11:2
references.pmid: 21223541
references.citation: Qual Health Res. 2003 Jul;13(6):871-83
references.pmid: 12891720
references.citation: Qual Health Res. 2005 Nov;15(9):1277-88
references.pmid: 16204405
references.citation: Acta Paediatr. 2004 Dec;93(12):1608-11
references.pmid: 15841769
references.citation: Ann Thorac Surg. 2003 Nov;76(5):1435-41; discussion 1441-2
references.pmid: 14602263
references.citation: J Intensive Care Med. 2004 Sep-Oct;19(5):243-58
references.pmid: 15358943
references.citation: Crit Care Med. 2007 Jun;35(6):1530-5
references.pmid: 17452930
references.citation: Pediatr Crit Care Med. 2007 Sep;8(5):447-51
references.pmid: 17693912