Impact of subspecialty consultations on diagnosis in the pediatric intensive care unit

Sonali Ramesh; Brennan Ayres; Patrick Ten Eyck; Jeffrey D. Dawson; Heather Schacht Reisinger; Hardeep Singh; Loreen A. Herwaldt; Christina L. Cifra

doi:10.1515/dx-2021-0137

Article

Impact of subspecialty consultations on diagnosis in the pediatric intensive care unit

Sonali Ramesh , Brennan Ayres , Patrick Ten Eyck , Jeffrey D. Dawson , Heather Schacht Reisinger , Hardeep Singh , Loreen A. Herwaldt and Christina L. Cifra

Published/Copyright: April 11, 2022

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From the journal Diagnosis Volume 9 Issue 3

Abstract

Objectives

Intensivists and subspecialists often collaborate in diagnosing patients in the pediatric intensive care unit (PICU). Our objectives were to characterize critically ill children for whom subspecialty consultations were requested, describe consultation characteristics, and determine consultations’ impact on PICU diagnosis.

Methods

We performed a retrospective study using chart review in a single tertiary referral PICU including children admitted for acute illness. We collected data on patients with and without subspecialty consultations within the first three days of PICU admission and determined changes in PICU clinicians’ diagnostic evaluation or treatment after consultations.

Results

PICU clinicians requested 152 subspecialty consultations for 87 of 101 (86%) patients. Consultations were requested equally for assistance in diagnosis (65%) and treatment (66%). Eighteen of 87 (21%) patients with consultations had a change in diagnosis from PICU admission to discharge, 11 (61%) attributed to subspecialty input. Thirty-nine (45%) patients with consultations had additional imaging and/or laboratory testing and 48 (55%) had medication changes and/or a procedure performed immediately after consultation.

Conclusions

Subspecialty consultations were requested during a majority of PICU admissions. Consultations can influence the diagnosis and treatment of critically ill children. Future research should investigate PICU interdisciplinary collaborations, which are essential for teamwork in diagnosis.

Keywords: communication; critical care; pediatrics; referral and consultation; teamwork

Corresponding author: Christina L. Cifra, MD, MS, Clinical Associate Professor, Department of Pediatrics, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 8600-M JCP, Iowa City, IA 52242, USA, Phone: (319) 384 8659, E-mail: christina-cifra@uiowa.edu

Funding source: National Center for Advancing Translational Sciences http://dx.doi.org/10.13039/100006108

Award Identifier / Grant number: UL1TR002537

Funding source: Agency for Healthcare Research and Quality

Award Identifier / Grant number: HS026965

Research funding: The use of REDCap^® in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) (UL1TR002537). Dr. Cifra is supported by the Agency for Healthcare Research and Quality (AHRQ) through a K08 grant (HS026965) and an internal start-up grant from the University of Iowa Carver College of Medicine Department of Pediatrics. Dr. Singh is partially supported by the AHRQ (R01HS27363) and Department of Veterans Affairs (VA) Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413). Dr. Reisinger and Dr. Ten Eyck are supported by an NIH Clinical and Translational Science Award (UL1TR002537) through the University of Iowa’s Institute for Clinical and Translational Science. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, AHRQ, or the Department of Veterans Affairs. The funding organizations played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit for publication.
Author contributions: Dr. Ramesh contributed to the conception and design of the study, collected, organized, analyzed, and interpreted the data, drafted the initial manuscript, and reviewed and revised the manuscript. Mr. Ayres contributed to the conception and design of the study, collected and interpreted the data, and reviewed and revised the manuscript. Dr. Ten Eyck and Dr. Dawson contributed to the conception and design of the study, analyzed and interpreted the data, and reviewed and revised the manuscript. Dr. Reisinger, Dr. Singh, and Dr. Herwaldt contributed to the conception and design of the study, interpreted the data, and reviewed and revised the manuscript. Dr. Cifra conceptualized and designed the study, collected, organized, analyzed, and interpreted the data, drafted the initial manuscript, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Competing interests: Authors state no conflict of interest.
Informed consent: The requirement for informed consent was waived by the authors’ Institutional Review Board.
Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the authors’ Institutional Review Board (University of Iowa IRB# 201712772).

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/dx-2021-0137).

Received: 2021-10-18

Accepted: 2022-03-08

Published Online: 2022-04-11

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Supplementary Material

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Keywords for this article

communication; critical care; pediatrics; referral and consultation; teamwork