Difference in number of new technological dependence patients acquire during hospitalization between usual care and intervention arms
We will measure new technology dependence like tracheostomy, gastrostomy tube, long term ventilation, bipap using VPS during the PICU hospitalization.
Difference in patient hospital-acquired conditions between usual care and intervention arm
Using VPS, investigators will track hospital acquired infections like catheter associated urinary tract infections and ventilator associated pneumonias
Difference in patient length of time on sedation medicines between usual care and intervention arm
Investigators will track the length of time on sedation medications used during intubations and when there is other medical equipment like chest tubes that it is not safe for patients to be moving. These medications include midazolam and fentanyl among others.
Difference in patients' new or progressive multiple organ dysfunction syndrome between usual care and intervention arm
Investigators will use the VPS designation of multiple organ dysfunction syndrome to characterize system failures like respiratory, renal, cardiac failure.
Difference in patient organ failure free days between usual care and intervention arm
Investigators will use the VPS designation of organ failure for systems like renal, respiratory and cardiac.
Difference in patient ventilator free days between usual care and intervention arm
Investigators will use the VPS designation for days up to 90 that the patient remains off of mechanical ventilation.
Difference in change in parent preferences for shared decision-making from baseline to patient discharge between usual care and intervention arm
A decision-analysis method will be used to administer and measure parental preferences for shared decision-making. Validation of the measure is completed but not yet published by the principal investigator.
Difference in change in parent preferences for control in decision-making from baseline to patient discharge between usual care and intervention arm
The Control Preferences Scale for Pediatrics (CPS-P), a validated tool, will be used to measure parent's preferences for control in decision-making.
Affects of Parent attachment style on communication preferences
The Relationship Questionnaire, a validated measure, will be used to measure parent relationship style, which is based on attachment theory.
Difference in change in parental levels of anxiety and depression from baseline to patient discharge between usual care and intervention arm
Parental levels of hospital anxiety and depression will be measured using the Hospital Anxiety and Depression scale (HADS).
Difference in change in parental levels of positive and negative affect from baseline to patient discharge between usual care and intervention arm
Parental levels of positive and negative affect will be measured using the Positive and Negative Affect Scale (PANAS), a validated tool.
Difference in change in parental levels of anger from baseline to patient discharge between usual care and intervention arm
Parent levels of anger will be measured using PROMIS bank v1.1- Anger scale.
Difference in change in parental levels of hope from baseline to patient discharge between usual care and intervention arm
Parental levels of hope will be measured using the Hope Scale, a validated tool.
Difference in change in Parent/family satisfaction with decision-making from baseline to patient discharge between usual care and intervention arm
Parent satisfaction with decision-making will measured through several question items designed to assess parent satisfaction with making decisions during their child's PICU visit. This measure was developed through extensive literature review and has been evaluated for face validity through cognitive interviewing and pilot testing with parents and families of children admitted to the ICU.
Difference in parent/family satisfaction with communication with their child's PICU physicians between usual care and intervention arm
The Pediatric Family Satisfaction in the Intensive Care Unit (pFS-ICU), a validated tool, will be used to measure parent satisfaction with communication with their child's PICU physician.
Difference in change in parent self-report of medical communication competence from baseline to patient discharge between usual care and intervention arm
The Medical Communication Competence Scale, a partially validated tool, will be used to measure parent self-reported competency with communication.
Difference in change in parent assessment of physician communication competency from baseline to patient discharge between usual care and intervention arm
The Communication Assessment Tool (CAT), a validated tool, will be used to measure parent perceptions of physician competence in interpersonal and communication skills.
Comparison of physician burnout between intervention and control group from baseline up to 600 days
The Maslach Stress and Burnout Inventory, a validated tool, will be used to measure the three aspects of the burnout syndrome: emotional exhaustion, depersonalization, and lack of personal accomplishment.
Physician satisfaction with the communication training and with the CCI experience.
Questions written for this study that have been written and piloted will assess the physicians' satisfaction and perceived usefulness of the communication training.
Evaluation of CCI provider experience in role of CCI and its feasibility of larger implementation
Both open ended survey questions and focus groups will be qualitatively analyzed to determine the benefits and burdens for providers of serving in the CCI role.
Comparison of physician comfort with end-of-life communication between intervention and control group from baseline up to 600 days
Physician comfort with end-of-life communication will be measured through several question items developed to assess how physicians feel about engaging in end of life discussions. The measure was developed through extensive literature review and has been evaluated for face validity through cognitive interviewing and pilot testing with PICU physicians.
Difference in timing of patient's limitations of interventions to death between usual care and intervention arm
As measured by a chart review of timing of limitations of interventions including do not resuscitate (DNR)/ do not intubate (DNI) and other limitations like no escalation of care will be described and the time to event of death will be compared.
Frequency of palliative care consultation between usual care and intervention arm
Medical chart review to determine request for and consultation performed by Pediatric Advanced Care Team (palliative care consultation service) will be measured and compared.
Physician competency in communication with families via objective structured clinical examination (OSCE) evaluation
CCI providers will be evaluated using a simulated patient and scored using a validated tool for communication skills including empathy in an encounter in the end-of-life setting.
Comparison of physician self-reported communication competency between intervention and control group
The Medical Communication Competence Scale, a partially validated measure will be used to assess physician self-reported competency.
Correlation between amount of CCI contact and parent and patient level outcomes
Investigators will categorize the extent of CCI contact and then determine if there is a correlation between amount of contact and parent and patient level outcomes.