Interaction with Pediatric Healthcare Providers Prior to Admission for Pediatric Critical Illness Due to Respiratory Failure

Objective: To describe pre-hospital healthcare provider contact and the impact of a child’s medical complexity on patterns of contact in the 7 days prior to admission for pediatric critical illness due to respiratory failure. Study Design: Retrospective analysis of data on patients ≤18 years with respiratory failure admitted to a quaternary pediatric intensive care unit between January 1, 2013 and December 31, 2014. Pre-hospitalization provider contact was compared to the child’s medical complexity using Chi square and Kruskal-Wallis tests for categorical and continuous data, respectively. Results: : Of 163 patients, the median age was 2.1 years, 59.5% were male, and 33.1% had medical complexity. In the 7 days prior to hospitalization, 68 families (41.7%) had 71 encounters with providers including primary care provider telephone call/office visit (66.2%), telephone contact/office visit with a specialist provider (31%), or urgent care visit (2.8%). Children without medical complexity were more likely than children with medical complexity to have a primary care provider telephone call/ office visit (36.7% vs 13.0%, p=0.004). In contrast, children with medical complexity were more likely to have a telephone call or office visit with a specialist (29.6% vs 5.5%, p<0.001). Conclusions: : In the 7 days before hospitalization for pediatric respiratory failure, nearly 1 in 2 families contacted a healthcare provider with illness-related concerns. During acute medical crisis, children without medical complexity were more likely to contact their primary care provider, while children with medical complexity were more likely to contact a specialist. These findings have important implications for pediatric care delivery.