Gregory Goldstein, MD
Pediatric Critical Care Fellow
Virginia Commonwealth University Medical Center
Richmond, VA
Disclosure information not submitted.
Oliver Karam, PhD, MD,
Professor, Division Chief
Virginia Commonwealth University Medical Center, United States
Disclosure information not submitted.
Nikki Miller Ferguson, MD
Associate Professor
Virginia Commonwealth University Medical Center
Richmond, Virginia, United States
Disclosure information not submitted.
Title: The Effects of Expectation Setting and Bundle Consent on Caregiver Stress in the Pediatric ICU
INTRODUCTION/HYPOTHESIS: Having a child admitted to the Pediatric Intensive Care Unit (PICU) is a stressful experience for caregivers and can have long-term negative mental health consequences. The goal of this study is to determine if formalized expectation setting for the care delivered in the PICU as well as bundle consent for five invasive procedures upon admission impacts the acute stress burden on caregivers of children admitted to the PICU.
Methods: A prospective cluster randomized controlled trial was performed. During control weeks, all patients admitted to the PICU were consented for invasive procedures using the current standard, separate consent obtained for each procedure. During experimental weeks, all patient admitted to the PICU were bundled-consented for Central Venous Catheter, Arterial Catheter, Peripherally Inserted Central Catheter, Intubation, and Procedural Sedation within 8 hours of admission, given a novel unit introductory letter and a “Common Procedures Explained” document. Caregivers were then asked to complete a demographic survey and Stress Overload Scale-Short tool 48-72 hours after their child’s admission to the PICU. We also evaluated the caregiver’s perception of the life-threatening nature of their child’s condition using a 5-point Likert scale. The association between consent method and caregiver stress outcomes (Personal Vulnerability, PV, and Event Load, EV, Score) were investigated using logistic regression models, adjusting for confounding factors.
Results: A total of 101 caregiver subjects were enrolled. Among the 72 in the control group, the median PV score was 9.5 and median EL score was 10.5. The 29 caregivers bundle consented had a median PV score of 9 and median EL score of 13 (p=0.517 and p=0.281, respectively). A caregiver’s perception of threat-to-life was not significantly related to the allocated group (control mean 3.4, experimental mean 3.1, p-value = 0.30).
Conclusions: This pilot study did not demonstrate significant differences in caregiver stress when bundled consent was obtained upon PICU admission. Larger studies are needed to definitively conclude if a particular method of consent is superior. However, we have shown that our experimental intervention, bundle consent, does not result in a significant increase in caregiver perceived severity of illness.