(326) Pediatric Intensive Care Unit Approaches to Conflict Handling (PATCH): Leadership Survey Results

Introduction: Conflict between patient families and clinicians in pediatric intensive care units (PICUs) is common and associated with worse patient safety, family satisfaction, and team well-being. Data demonstrate disparities in conflict management. PICU conflict management is underexplored, with no studies describing existing approaches.

Methods: This was a prospective, multi-site, mixed methods analysis of PICU leadership surveys, approved by the local IRB. Survey sections included demographics, management approaches, and case scenarios. Using purposive and snowball sampling, we emailed closed survey invitations to 100 PICU medical directors and 20 nursing directors. Survey design, distribution, and reporting adhered to CHERRIES checklist. Descriptive statistics and bivariate analyses were performed.

Results: Response rate was 57% (68/120). Frequent conflict sources were: poor communication (51%), coping problems (31%), difficulty comprehending prognosis (20%), care plan disagreements (20%), and life-sustaining therapy (17%). Frequent interventions were: social work (97%), patient-family relations (56%), behavior contracts (32%), security (19%), and ethics (8%).

Respondents reported having conflict management policies frequently (65%); only 23% reported tracking outcomes. 38% track behavior contract use; 18% track disparities in use. 98% have a diversity, equity, and inclusion (DEI) office, 52% involve them ad hoc, and 5% do so systematically. Larger institutions were more likely to involve DEI offices in conflict management (p=0.05). For the general conflict management questions, we found no significant response differences across respondent or institution characteristics. For the case scenarios, respondents’ approaches varied; the most frequent initial conflict responses were care conferences, social work, and ethics involvement. Larger PICUs were more likely to have specific policies to address each conflict (p < 0.05).

Conclusions: PICU conflict management varied across respondents, including when presented with specific case scenarios. Learning from existing management approaches may help develop standardized interventions to reduce conflict and improve interventions. The wide range of approaches selected suggests systematic, generalizable, and consistent approaches to conflict may be worthwhile.