Virtual Family-Centered Rounds to Improve Best Practice Care Delivery and Psychosocial Outcomes in the Pediatric Intensive Care Unit

About This Grant

PROJECT SUMMARY / ABSTRACT This project will improve best practice care delivery and psychosocial outcomes for families of critically ill children hospitalized in the pediatric intensive care unit (PICU). The focus of this proposal is family-centered rounds (FCR), which is recognized as a best practice for hospitalized children. FCR enhances family-centered communication, engagement, understanding of the care plan, and trust in providers. Importantly, these benefits are also strategies to mitigate PICU-related psychosocial harms to family members of the critically ill child. However, FCR is only possible when parents or guardians (“parents” hereafter) can be physically at bedside during rounds. Yet circumstances that prevent physical presence (e.g., work, travel) hinder some families. PICUs lack evidence-based strategies to promote parents’ access to and attendance at FCR. We address this critical gap by testing a telehealth intervention to expand access to and attendance at FCR. We propose a dual cluster randomized trial, which is two simultaneous randomized trials: one testing the intervention of inviting families to use virtual FCR and one testing implementation strategies. Families will be randomized to one of three arms: (1) virtual FCR plus digital navigators (active implementation strategy), (2) virtual FCR plus informative handouts/videos (control implementation strategy), and (3) usual care. In this proposal, we pursue three Specific Aims: Evaluate and compare the impact of providing parents the option of virtual FCR versus usual care on parent FCR attendance, utilization, and psychosocial outcomes (Aim 1). Evaluate and compare two implementation strategies for virtual FCR (Aim 2). Conduct a mixed methods implementation evaluation of the virtual FCR intervention (Aim 3). Aims 1 and 2 will measure heterogeneity of intervention effects and implementation effects, respectively, by pre-specified subgroups. Our team’s preliminary research found that the option to use telehealth to conduct virtual FCR improved parent FCR attendance. All groups benefited from the intervention except for those with the lowest digital literacy and those without a smartphone. We thus build on our prior work to now propose a type 2 hybrid study utilizing the rigorous but underused dual randomized trial design. Our team’s expertise encompasses hospital care delivery interventions, clinical trials, implementation science, community engagement, linguistically appropriate care, mixed methods, and advanced statistics. Our team also includes two patient/provider advisory groups. This application is responsive to NICHD priorities in that it focuses on psychosocial issues related to the care of critically ill children and their families by transforming the delivery of PICU care to be more family- centered and accessible. In summary, this project will advance an innovative FCR solution in the PICU to address families’ unmet needs; and improve parent FCR attendance, healthcare utilization, parent mental health, and sibling well-being.