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Optimizing Care for Pediatric Cancer Patients in the Pediatric ICU: A Collaborative and Synergistic Approach

Kalee Grassia, MD, MS, Danny Loeb, MD, MEd, Maya Dewan, MD, MPH

We are proud to report that Cincinnati Children’s was named the #1 hospital for pediatric cancer in the country by US News and World Report this year and the very sickest of these patients are cared for in the PICU. As the top center for cancer in the nation, we receive the children who most need our help from the region, the country, and the world. Unfortunately, these children, who arrive sick often get sicker, often require care in the Pediatric Intensive Care Unit (PICU). Currently, patients with hematologic and oncologic diseases make up almost 20% of our critical care patient days. Given the highly specialized care that these patients require there is a high degree of collaboration between the critical care team and the oncology/ Bone Marrow Transplant (BMT) teams. With optimization of care of the sickest pediatric cancer and BMT patients in mind, the idea of a formal collaborative between the PICU and Cancer and Blood Disease Institute (CBDI) was born.

Our goal was to synergize and optimize care so patients can receive the best possible care and families have a unified experience during their time at CCHMC. First, we gathered baseline data from the care team in the ICU including nurses, respiratory therapists, doctors and nurse practioners with a range of experience. From this data the collaborative learned that, not surprisingly, these patients are some of the most rewarding, but also some of the most challenging patients to care for in the ICU. Some of the challenges included inconsistencies in care. With this data, we have begun to implement interventions that are focused on enhancing care delivery for patients and training for the staff managing oncology and BMT patients.  Specifically, this collaborative has focused on improving how we communicate and hand off information about these complex patients when they are transferring care and throughout their stay in the PICU. The collaborative has created unique educational opportunities, including simulation-based training and an onco-critical care training month for the care providers in the PICU. A nurse champion role was also created in an effort to provide continuity of care for patients and families as they move between the oncology/BMT floors and the PICU.

We are also proud to report that we are launching a unique training opportunity for pediatric intensivist through the combined efforts of the division of Critical Care and the Cancer and Blood Disease Insititute. In July, I will be the first Onco-Critical Care fellow at CCHMC. I plan to complete my training in pediatric critical care in July and stay on for this additional one-year fellowship. Given the preeminent status of both our CBDI and Critical Care Medicine programs, this is a distinctive opportunity for CCHMC to train the next generation of onco-intensivists. In addition to patient care, the fellowship will have a special emphasis on optimization of care spanning organizational structure, specialized equipment, and specific clinical algorithm and research infrastructure.

In only a few short months, the oncology-critical care collaborative has established robust pathways which transcend either division, invested heavily in onco-critical care education, and established a promising academic training program. Collectively, these endeavors ensure that we live up to our reputation as the best pediatric oncology program with the best children’s hospital in the country.  This cross-divisional collaborative is an innovative approach to enhancing care for some of the sickest patients in the hospital. These children and families deserve the best care via a multidisciplinary approach, as we push the envelope to continue to improve outcomes. We are excited to see what the future of this collaborative will hold.


Optimizing Care For Pediatric Cancer Patients In The Pediatric ICU:  A Collaborative And Synergistic Approach
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