P2A219: Caring for Pediatric Intensive Care Unit Survivors: Perspective of Primary Care Pediatricians

Background: Post Intensive Care Syndrome – Pediatrics (PICS-P) is the constellation of physical, cognitive, social, and emotional impairments experienced by patients and their caregivers after a pediatric intensive care unit (PICU) admission. Follow-up with a primary care provider (PCP) is integral in post-PICU care for identification and management of PICS-P domains. Improving care for children after a PICU admission, specifically as it relates to identification and management of PICS-P, requires an understanding of the barriers pediatric primary care providers experience while providing this care. We hypothesize that primary care pediatricians have reduced awareness of PICS-P and experience provider-level and systems-level barriers to providing care for children after a PICU admission.

Methods: We performed a pilot cross-sectional survey study of primary care providers. The survey included 15 questions on primary care provider demographics, comfort with and barriers (apriori defined based on prior literature) to providing care for children after a PICU admission, knowledge of and screening practice for PICS-P, and resource needs. We calculated median values for continuous data and frequencies for categorical data from the survey using STATA version 14.

Results: Of the 26 participants, the median age was 38.5 years and 73% were female. Median number of years in practice was 6.5 and median number of providers in their practice was 7. In case studies of former PICU patients, 100% of participants were “very comfortable” resuming care for a patient with a straightforward bronchiolitis PICU admission while 43% of participants were “neutral to not at all comfortable” with caring for a patient after a complex acute respiratory distress syndrome PICU admission. Regarding apriori defined barriers to providing care after a PICU admission, the greatest barriers reported were care coordination with specialty providers (69%), inadequate or missing documentation (69%), and discomfort or difficulties with managing increased medical complexity (54%). Twenty-three percent of participants were familiar with the term “post-intensive care syndrome in pediatrics.” Over 50% of participants screened for four of five PICS-P domains. Screening was done by history and physical (84%) or with the pediatric symptom checklist (15%).

Conclusion: In this pilot study, we found that only 23% of primary care pediatricians had knowledge of PICS-P. However, over half of participants screened for nearly all PICS-P domains, mainly through history and physical exam. Participants noted decreased comfort in providing care to children after a complex PICU admission and experienced numerous care barriers. While surveying a larger sample of primary care provider pediatricians is needed, this pilot data identifies three areas of needed improvement in post-PICU care. Providing education on PICS-P for primary care providers, increased uptake of validated tools to screen for PICS-P, and systems-level efforts to reduce care barriers to ensure patient and family needs are fully addressed after a PICU admission.