Is this as good as it gets? Implications of an asymptotic mortality decline and approaching the nadir in pediatric intensive care
Autor: | Katie M. Moynihan, Raman Krishna Kumar, Danielle D. DeCourcey, Efrat Lelkes |
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Rok vydání: | 2021 |
Předmět: |
Pediatric intensive care unit
Mortality Decline medicine.medical_specialty business.industry media_common.quotation_subject Benchmarking Excellence Intensive care Pediatrics Perinatology and Child Health Global health Medicine Quality (business) business Intensive care medicine Nadir (topography) media_common |
Zdroj: | European Journal of Pediatrics. 181:479-487 |
ISSN: | 1432-1076 0340-6199 |
Popis: | Despite advances in medicine, some children will always die; a decline in pediatric intensive care unit (PICU) mortality to zero will never be achieved. The mortality decline is correspondingly asymptotic, yet we remain preoccupied with mortality outcomes. Are we at the nadir, and are we, thus, as good as we can get? And what should we focus to benchmark our units, if not mortality? In the face of changing case-mix and rising complexity, dramatic reductions in PICU mortality have been observed globally. At the same time, survivors have increasing disability, and deaths are often characterized by intensive life-sustaining therapies preceded by prolonged admissions, emphasizing the need to consider alternate outcome measures to evaluate our successes and failures. What are the costs and implications of reaching this nadir in mortality outcomes? We highlight the failings of our fixation with survival and an imperative to consider alternative outcomes in our PICUs, including the costs for both patients that survive and die, their families, healthcare providers, and society including perspectives in low resource settings. We describe the implications for benchmarking, research, and training the next generation of providers. Conlusion: Although survival remains a highly relevant metric, as PICUs continue to strive for clinical excellence, pushing boundaries in research and innovation, with endeavors in safety, quality, and high-reliability systems, we must prioritize outcomes beyond mortality, evaluate “costs” beyond economics, and find novel ways to improve the care we provide to all of our pediatric patients and their families. |
Databáze: | OpenAIRE |
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