Elyssa Faigen, MD
Pediatric Critical Care Fellow
Rainbow Babies & Children's Hospital
Cleveland, Ohio
Disclosure information not submitted.
Katherine Slain, DO
Dr.
Rainbow Babies and Childrens Hospital, United States
Disclosure information not submitted.
Title: Patterns of Social Resource Referrals for Children Admitted to the Pediatric Intensive Care Unit
Introduction/Hypothesis: An admission to the pediatric intensive care unit (PICU) is stressful, especially for socially fragile families. These families could benefit from hospital-based resources such as social work (SW), but to date, there are no studies describing the use of these resources in families of different socioeconomic status (SES). Therefore, the objective of this study was to describe patterns of social resource referral in families of varying SES with children admitted to the PICU.
Methods: With IRB approval, the electronic medical record was queried to include patients admitted to the PICU two weeks of every month in 2016 to ensure random sampling. Collected variables included demographics, insurance status, discharge diagnosis, length of stay, and occurrence of SW, palliative care, psychiatry, and spiritual care consults during PICU admission. Using US Census Bureau data, patient addresses were geocoded to census tracts that were then matched to the Childhood Opportunity Index (COI) (diversitydatakids.org) data. The COI is a quantifiable measure of relative neighborhood opportunity incorporating indicators associated with child well-being. Patients were categorized into COI quintiles: very low, low, moderate, high, or very high opportunity neighborhoods. The rates of resource utilization were compared between groups. Standard statistical methods were used.
Results: This cohort of 356 children had a median age of 67 months [IQR 15-167] and 53% were male. Most children were living in very low (37.9%) or low (13.8%) COI neighborhoods. There were differences in race (< 0.001) and insurance status (p< 0.001) among children living in different COI neighborhoods. There were differences in SW referrals by COI (very low 31%, low 45%, moderate 17%, high 19%, very high 16%, p=0.002) and palliative care consults by COI (very low 1.5%, low 12%, moderate 9%, high 5%, very high 12%, p=0.02). There were no differences in psychiatric consults (p=0.602) or spiritual care consults (p=0.281) by COI.
Conclusions: Among this cohort of predominantly low SES children admitted to the PICU, referral to hospital-based social resources was low, suggesting there is an opportunity to improve care provided to critically ill children living in resource-poor neighborhoods.