TOP 73 - Implementing an Inpatient Pediatric Complex Care Consult Service: The First 6 Months

Publication Number: 2826.TOP 73

Rachel E. Bethune Howard, Boston Children's Hospital, Boston, MA, United States; Stacey Cook, Boston Children's Hospital, Boston, MA, United States; Walter Wickremasinghe, Boston Children's Hospital, Boston, MA, United States; Jay Berry, Boston Children's Hospital, Boston, MA, United States

Background: Children with medical complexity (CMC) have severe, chronic, multisystem conditions with frequent medical technology use. This population accounts for a disproportionate share of healthcare utilization, hospital days, and overall costs. Complex care providers have established expertise in the longitudinal management of pediatric chronic illness, coordination across specialties, technology dependence, and family-centered shared decision-making. While the benefits of outpatient complex care involvement are well documented, many CMC require admission to the intensive care unit (ICU), and a subset go on to develop chronic critical illness. The role and impact of complex care providers during ICU admissions remain poorly defined. Implementing and evaluating inpatient complex care consultation in the ICU setting may clarify the scope, potential benefits, and contributions to care delivery for CMC during critical illness and transitions of care through the ICU.

Objective: The objective of the study is to characterize the demographic information, clinical indications, and interventions of a newly created and implemented Complex Care Consult Service for CMC admitted to the intensive care units at a large quaternary care children’s hospital during the first 6 months of the consult service pilot program.

Design/Methods: With iterative input, a new complex care consult service was developed, launched, and piloted at a large quaternary care children's hospital. The medical, surgical, or cardiac intensive care units or ICU steps down teams were able to request complex care consultation for children meeting criteria for medical complexity admitted to the units from May 2025 – October 2025 based on one of four indications: (1) Evaluation and management of chronic medical conditions (2) Involvement in decision-making for medical technology, treatment plan, or surgical procedure (3) Polypharmacy or (4) Complex care coordination at transitions of care. For each patient, the primary outcome measures were: (1) demographic information (age, sex, number of medical technologies, number of systems involved) (2) number and type of interventions provided (e.g., chronic disease management, polypharmacy review, medical technology evaluation etc.) (3) frequency of follow-up notes per admission. Secondary outcomes include time from consult to discharge, involvement in family-team meetings, and 30-day readmission rates. Next steps for future studies include understanding the ICU providers' opinions on the consult, and patient/family perspectives on complex care provider involvement during their ICU admission.