A specialized multi-disciplinary care program for children with sepsis and multiple organ dysfunction-associated immune dysregulation

Abstract

The complex physiology and medical requirements of children with sepsis and multiple organ dysfunction syndrome (MODS) challenge traditional care coordination models. While the involvement of multiple clinical subspecialty services is often necessary to support different care processes and individual organ system dysfunctions, it can also delay the diagnostic process, monitoring, and treatment. The logistics of coordinating with many specialty providers for critically ill patients are challenging and time consuming, and often can result in fragmented communication. To address these and other related issues, we developed a new multi-disciplinary consult service focused on streamlining diagnostics, management, and communication for patients with sepsis and MODS-associated immune dysregulation. The service, called the Program in Inflammation, Immunity, and the Microbiome (PrIIMe), is now a hospital-wide clinical consult service at our institution caring for a broad group of patients with immune dysregulation, particularly focusing on patients with sepsis and MODS. In this paper, we summarize the development, structure, and function of the program, as well as the initial impact. This information may be helpful to clinicians and healthcare leaders who are developing multi-disciplinary consult services for children with complex care needs, especially those with sepsis and MODS-associated immune dysregulation. IMPACT: The care of children with sepsis and multiple organ dysfunction-associated immune dysregulation requires rapid and flexible involvement of multiple clinical subspecialists that is difficult to achieve without fragmented care and delayed decision making. In this narrative review we describe the development, structure, and function of a multi-disciplinary consult service at a children's hospital dedicated to helping coordinate management and provide continuity of care for patients with sepsis and multiple organ dysfunction-associated immune dysregulation. This information may be helpful to clinicians and healthcare leaders who are developing multi-disciplinary consult services for children with complex care needs, especially those with sepsis and MODS-associated immune dysregulation.

Fig. 1. PrIIMe consult criteria.

General patient characteristics to guide consideration for PrIIMe consult.

Fig. 2. PrIIMe Team Process.

This figure is a flow chart that depicts the key components of a PrIIMe consult for a critically ill patient. Launch team refers to the patient’s primary service providers and the on-service PrIIMe APN and attending. Core team refers to the broad PrIIMe team including all relevant specialists and additional PrIIMe team members participating in the initial consult discussion and any follow-up as needed.

Fig. 3. PrIIMe Team Structure.

This figure depicts the key providers involved in a PrIIMe consult in a critically ill patient, including the primary ICU team who requests the consult and conveys the consult needs, the on-service PrIIMe team (APN and attending), the additional core PrIIMe team members who may participate in the consult, and the additional specialists as needed customized to the patient’s clinical status.