Inadequate communication between medical teams and families can lead to errors and poor-quality care. The objective was to understand why communication between the clinical team and families was not occurring consistently in the pediatric intensive care unit and improve the system using a multidisciplinary improvement team including a family advisor. This improvement project used Lean Six Sigma. The team observed updates and collected documented communication, survey, interview, and focus group data from families and staff. Root causes of failures included lack of assigned responsibility, lack of defined daily update, and lack of a daily communication standard. Process changes were implemented, resulting in an increased mean documented communication rate from 13% pre intervention to 65% post intervention that was sustained for more than 2 years (P < .001). Including a family advisor as an equal member of an improvement team provides family empowerment and a greater chance of success in complex areas.

The coronavirus disease 2019 (COVID-19) pandemic has created numerous risk factors for families and children to experience toxic stress (TS). The widespread implementation of lockdowns and quarantines contributed to the increased incidence of domestic abuse and mental health issues while reducing opportunities for effective action, including social and educational interventions. Exposure to TS negatively affects a child’s development which may result in a lasting impact on the child’s life, as measured by tools, such as Adverse Childhood Experiences (ACE) score. When TS becomes highly prevalent within a society, it may develop into a health security threat, both from short- and long-term perspectives. Specific resources to combat the pandemic have been put in place, such as COVID-19 vaccines, novel therapeutics, and the use of telemedicine. However, the overall implementation has been challenging due to a multitude of factors, and more effort must be devoted to addressing issues that directly or indirectly lead to the emergence of TS. Only then can we begin to reduce the incidence and intensity of pandemic-associated toxic stress.

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A 17-year-old male with no significant past medical history presented to the emergency department with severe sepsis of unknown etiology. The patient was found to have septic thrombophlebitis of the internal jugular vein with multiorgan dysfunction and septic embolization to both lungs. The patient was also noted to have COVID-19 IgM antibodies and multiple close COVID-19 exposures prior to the patient's emergency department presentation. Here, we present the prolonged and complicated hospitalization of this patient and a review of this rare but important disease.