Enhancing Care for Hospitalized Children With Medical Complexity via Targeted Education

Abstract

OBJECTIVES: Children with medical complexity (CMC) and their caregivers face multifaceted challenges during hospitalization. Pediatric residents are often frontline clinicians for these patients but frequently identify feelings of inadequate preparedness to meet their care needs. We assessed the impact of a multimodal curriculum on common acute and chronic medical devices in CMC on caregiver-reported resident communication. We hypothesized that targeted education would translate to improved caregiver perception of family-centered communication. METHODS: We implemented a novel medical device curriculum for pediatric residents at 2 children's hospitals. Caregivers of hospitalized CMC completed a modified 14-item Communication Assessment Tool pre- and post-curricular intervention. We used generalized estimating equations at the caregiver level and paired t tests at the resident level to evaluate pre-post changes. We compared postintervention scores with those of a cohort of unexposed residents. RESULTS: We collected 253 surveys on 39 pediatric residents. At the resident level, there was a statistical increase in overall mean score following intervention (pre, 4.844/5 [SD = 0.213]; post, 4.934/5 [SD = 0.132]; P = .0328). At the caregiver level, mean survey scores increased, although this was not statistically significant. Four of 14 survey items showed statistical improvement following intervention. Caregiver-level outcomes were consistent in the sensitivity analysis using an unexposed control, indicating robustness of findings. CONCLUSION: Caregivers of CMC reported modest improvements in resident collaborative communication behaviors following intervention. Ongoing deliberate practice, including expanded educational models and the integration of caregiver feedback into physician evaluation tools, may further support skill development for clinicians caring for hospitalized CMC.