Provider Perceptions of Outcomes in the Pediatric Cardiac Intensive Care Unit.

Abstract

In the pediatric cardiac intensive care unit (PCICU), predicting the complications and long-term impact of extracorporeal membrane oxygenation (ECMO) and cardiopulmonary resuscitation (CPR) is influenced by the providers' perceptions. Little is understood about such perceptions as they relate to provider role and experience. A multi-disciplinary group in the PCICU of a single center was surveyed regarding two patient scenarios: (1) ECMO after cardiac surgery, and (2) cardiac arrest with need for CPR. Respondents indicated their risk tolerance for potential complications of these interventions, and the impact on patient health-related quality of life (HRQoL). Responses were compared based on providers' role and experience. 101 providers were surveyed and were willing to tolerate a 50% risk of death with ECMO or continued CPR but had less tolerance for the risk of other long-term morbidities. For most potential complications, nurses had the lowest risk tolerance and attending physicians the highest. Provider experience had no impact on risk tolerance. All providers underestimated HRQoL scores compared to previously published scores of patients who survived the surveyed scenarios. This survey is one of the first to explore providers' perceptions of ECMO and CPR. PCICU providers are more willing to accept the risk of death than other morbid complications, and poorly predict HRQoL outcomes. Team members have varied risk tolerance for complications and predict their impact differently. Understanding the variability of and influences on perceptions of patient outcomes could help improve communication with patients and families, team dynamics, and decision-making in the PCICU.