Pediatric Neurocritical Care: Maximizing Neurodevelopmental Outcomes Through Specialty Care

Carpenter, Jessica

doi:10.1016/j.pediatrneurol.2023.08.006

Pediatric Neurology

2023

DOI: 10.1016/j.pediatrneurol.2023.08.006

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Pediatric Neurocritical Care: Maximizing Neurodevelopmental Outcomes Through Specialty Care

Jessica Carpenter

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2024

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Cited by 3 publications

(2 citation statements)

References 195 publications

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“…2 Therefore, pediatric neurocritical care (PNCC) has potential to significantly improve the outcomes of children facing critical illness but is yet to be uniformly established as an independent specialty among pediatric centers. 3 Expert nursing staff are essential for specialized patient care units, because nurses are often the first to recognize and respond to clinical changes. Nurses can ensure timely care and adherence to best practices.…”

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confidence: 99%

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Sustainability of a Pediatric Neurointensive Care Unit Model Within a Mixed Pediatric Intensive Care Unit and Its Effect on Nursing Sentiment

Chang,

Casazza,

Sperber

et al. 2024

Journal of Neuroscience Nursing

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BACKGROUND: Pediatric neurocritical care (PNCC) and pediatric neurointensive care units (neuro-PICU) are growing fields. Although some institutions have established independent neuro-PICUs meeting most Neurocritical Care Society (NCS) standards for neurocritical care units, many centers lack the resources to do so. We describe an alternative neuro-PICU model as a designated unit within a mixed pediatric intensive care unit (PICU) and its effects on nursing sentiment. METHODS: We established a 6-bed neuro-PICU within a 36-bed noncardiac PICU. Charge nurses were tasked with admitting PNCC patients into these beds. For nursing expertise, we used a core group of 12 PNCC specialty nurses and instituted PNCC nursing education to PICU nurses. We observed the number of PNCC patients admitted to neuro-PICU beds and surveyed charge nurses to identify barriers to assigning patients. We surveyed PICU nursing staff to explore sentiment regarding PNCC before and after establishing the neuro-PICU. Nursing criteria were compared with NCS standards. RESULTS: In the 40-month period, our PICU saw 2060 PNCC admissions. Overall, occupied neuro-PICU beds housed PNCC patients 74.1% of the time. The biggest barriers to patient placement were too many competing placement requests, not enough neuro-PICU beds when specialty census was high, and difficulty assigning one nurse to two PNCC patients. In surveys after establishing the neuro-PICU, compared to before, experienced nurses reported being more interested in obtaining Emergency Neurological Life Support certification (94.2% vs 80.6%, P = .0495), and inexperienced nurses reported being more familiar with PNCC clinical pathways (53.5% vs 31.7%, P = .0263). Most NCS criteria related to nursing organization were met. CONCLUSIONS: Focused neuro-PICUs should be developed to complement advances in the field of PNCC. Alternative neuro-PICU models are possible and can increase nursing interest in further education and awareness of clinical pathways, but barriers exist that require institutional commitment to nursing development to sustain the delivery of specialized care to this population.

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confidence: 99%

“…11 Many institutions have neither the resources nor the patient volume to maintain such a practice. 3 Moreover, nurses' attitudes and perceptions can impact buy-in for ongoing professional development. 12 Therefore, alternative models for neuro-PICUs and nursing sentiment regarding the subspecialty need to be explored.…”

mentioning

confidence: 99%

Sustainability of a Pediatric Neurointensive Care Unit Model Within a Mixed Pediatric Intensive Care Unit and Its Effect on Nursing Sentiment

Chang,

Casazza,

Sperber

et al. 2024

Journal of Neuroscience Nursing

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Multidisciplinary Consensus on Curricular Priorities for Pediatric Neurocritical Care Nursing Education: A Modified Delphi Study in the United States

Chang,

Louderback,

Hammett

et al. 2024

Neurocrit Care

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Standardized therapies after ECMO program (STEP); a novel approach to pediatric post-ECMO care

Shappley,

Holder,

Poplos

et al. 2024

J Extra Corpor Technol

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Background: The study objective was to characterize compliance with Standardized Therapy after ECMO Program (STEP), an intentional discharge pathway for extracorporeal membrane oxygenation (ECMO) survivors in a US pediatric hospital. Methods: The program identified pediatric ECMO survivors before discharge, reviewed and requested appropriate consultations, educated families on ECMO sequelae, and sent ECMO summaries to pediatricians.Compliance with institutional post-ECMO guidelines was evaluated before and after STEP implementation. Results: We identified 77 ECMO survivors to hospital discharge (36 [46.8%] before and 41 [53.2%] after STEP implementation). There was a significant increase in complete (38.8% .vs 74.2%, p < 0.001) and time-appropriate neurodevelopmental testing (71.4% vs. 95.6%, p = 0.03). Significant increase in inpatient evaluations by neurology (52.7% vs. 75.6%, p = 0.03) and audiology (66.7% vs. 87.8%, p = 0.02), and in referrals for outpatient audiology (66.6 vs. 95.1%, p = 0.002), physical therapy (P.T.) (63.8% vs. 95.1%, p = 0.001), occupational therapy (O.T.) (63.8% vs. 95.1%, p = 0.001) and speech-language pathology (S.L.P.) (55.5% vs. 95.1%, p < 0.001) were noted. Conclusion: Implementing an intentional discharge pathway for pediatric ECMO survivors (STEP) successfully increases inpatient and outpatient compliance with hospital and Extracorporeal life support organization (ELSO) follow-up guidelines. It leads to timely and complete neurodevelopmental evaluation.

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Pediatric Neurocritical Care: Maximizing Neurodevelopmental Outcomes Through Specialty Care

Cited by 3 publications

References 195 publications

Sustainability of a Pediatric Neurointensive Care Unit Model Within a Mixed Pediatric Intensive Care Unit and Its Effect on Nursing Sentiment

Sustainability of a Pediatric Neurointensive Care Unit Model Within a Mixed Pediatric Intensive Care Unit and Its Effect on Nursing Sentiment

Multidisciplinary Consensus on Curricular Priorities for Pediatric Neurocritical Care Nursing Education: A Modified Delphi Study in the United States

Standardized therapies after ECMO program (STEP); a novel approach to pediatric post-ECMO care

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