Feasibility and acceptability of the Critical Illness Recovery for ChiLdrEn (CIRCLE) program

Research Objectives: To explore the feasibility and acceptability of implementing the Critical Illness Recovery in ChiLdrEn (CIRCLE) program among families at risk for Post-Intensive Care Syndrome in pediatrics (PICS-p).

Design: Longitudinal quality improvement

Setting: A 36-bed pediatric intensive care unit (PICU) and outpatient multidisciplinary clinic

Participants: Families of children aged < 18 years admitted with newly acquired brain injury or requiring extracorporeal membrane oxygenation (ECMO) support during their PICU stay.

Interventions: CIRCLE program multi-pronged approach: 1) PICU bedside engagement, 2) family education regarding PICS-p and CIRCLE; 2) comprehensive child and family functioning assessment via patient/proxy-reported measures (baseline, discharge, 1-3 month post-discharge); 3) multidisciplinary PICU rounds; 4) CIRCLE clinic visit post-discharge.

Main Outcome Measures: Primary outcomes were program feasibility, assessed via rates of family engagement, outcome measure completion, clinic attendance, and CIRCLE acceptability, via satisfaction survey. Outcome measures captured caregiver and child physical and mental health, family functioning, and child behavior, cognition, sleep, health-related quality of life, community participation, and return to school.

Results: From September 2021–July 2022, 140 families met program criteria, 74 were approached, and 63 (85%) participated. Of those not approached (N=71), 27 caregivers were unavailable, 22 children were end-of-life, 9 were >17 years, 5 were in child-youth-and family custody, and 2 caregivers did not speak English. Outcome measures were completed by 42 of 63 families at baseline (67%), 25 of 43 at discharge (58%), and 15 of 33 (45%) 1-3-months post-discharge. Thirty families made CIRCLE clinic appointments for follow-up. Of those, 25 (86%) attended and 13 (43%) families completed an acceptability survey in clinic and reported CIRCLE improved their hospitalization (100%) and agreed-to-strongly agreed CIRCLE’s resources and materials were helpful (e.g., PICU journal) (100%), that CIRCLE engagement was valuable for their family (92%) and eased the stress of recovery (85%).

Conclusions: Families reported CIRCLE was acceptable and beneficial. Next steps include characterizing recovery trajectories and soliciting PICU family engagement to optimize program implementation and refine data collection.

Author(s) Disclosures: Funded in part by the UPMC CHP Foundation.