Clinical Pearls.

Abstract

Most children born with a congenital heart defect (CHD) survive; however, those who require intervention during the neonatal period are more susceptible to neurodevelopmental disabilities. Developmental care improves outcomes in premature infants, but little evidence addresses the impact on infants with CHD.Elhoff and colleagues evaluated the use of developmental care rounds in their pediatric cardiac intensive care unit for a 2-year period. Their developmental care rounds comprise the following: Families are included in developmental care rounds and are asked at the start how they have been able to interact/bond with their infant. This guides the discussion on the plan of care.A weekly facilitator selects the patients to include in the rounds, on the basis of established criteria, and provides the family 24 hours’ notice.The team includes various disciplines such as physical, occupational, and/or speech therapists, child life, social work or chaplain, bedside nurse, and the therapy leader.Use of developmental care rounds in this unit showed sustained family involvement in more than 85% of rounds during the 2 years. The team used a virtual format during the pandemic but later moved to a hybrid format that still allows participation of team members and families who cannot be physically present.See Article, pp 494-498Patients with COVID-19–related acute hypoxemic respiratory failure and prolonged mechanical ventilation may require a tracheostomy. Research reports on COVID-19 transmission during a tracheostomy procedure have shown limited viral transmission, yet the reports have been primarily anecdotal.Standiford and colleagues investigated the rate of transmission of COVID-19 to health care workers (HCWs) during a tracheostomy protocol, as well as HCWs’ beliefs and attitudes on safety. They found Ninety-two percent of the HCWs described feeling extremely or moderately safe during the procedure.Five percent of the HCWs reported new symptoms or a positive COVID-19 test within 21 days after the tracheostomy procedure.Seven percent reported breaches of procedure protocol.The findings show that most HCWs were familiar with and adhered to institutional protocols. The authors recommend multidisciplinary engagement in development and implementation of tracheostomy procedure protocols as well as dedicated tracheostomy teams to streamline the procedure and limit the number of providers potentially exposed to COVID-19.See Article, pp 452-460Effective teamwork consists of interprofessional collaboration, cooperation, coordination, communication, and partnership. Intensive care units (ICUs) with low levels of these are often associated with worse patient outcomes and staff satisfaction. Provision of high-quality care depends on a healthy work environment (HWE), yet little is known about the perceptions of ICU teamwork from a “whole team” perspective.Pun and colleagues surveyed more than 3500 staff (nurses, nursing assistants, pharmacists, physicians, rehabilitation therapists, and respiratory therapists) on their perceptions of ICU teamwork and HWE. They found Overall scoring of interprofessional team collaboration was 3.92 (scale 1-5), with nursing assistants scoring the highest (4.18) and pharmacists the lowest (3.83).Scores on the HWE Assessment Tool (scale 1-5) were similar (3.45): highest for physician trainees (3.66), lowest for respiratory therapists (3.38).Among all the professions, nurses rated the appropriate staffing domain the lowest.The ratings for teamwork and HWE by the ICU team could be considered good but not great. The authors suggest that specific training on interprofessional communication and leadership occur in professional schools and in health care organizations.See Article, pp 443-451Many terms are used to describe major medical treatments—such as life support, life-sustaining treatment, withdrawing treatment—and the definitions have become more complicated as technology and care have evolved. The result is confusion for patients and families who must make a decision about the use of major medical treatments.Pecanac and colleagues explored the dialogue that patients and families used to describe their experience with decision-making about major medical treatments for themselves or someone else. They found Respondents’ descriptions indicated that they conceptualized major medical treatments as “keeping the patient alive” and forgoing major medical treatments as meaning that death would occur.Respondents understood that major medical treatments can have adverse consequences, such as pain or an undesirable neurological state.Understanding how patients and families make sense of major medical treatments can help clinicians during decision-making conversations.See Article, pp 461-468