(735) Implementation of a Pediatric Pulmonary Post-ICU Clinic: Lessons Learned and Future Directions

Introduction: Many pediatric survivors of intensive care are discharged with new and ongoing medical issues. To meet these needs, we developed a post-intensive care clinic in the Pulmonary Division at Boston Children’s Hospital (BCH). Children receiving treatment for acute/acute on chronic respiratory failure in Medical Critical Care at BCH were referred and seen by pulmonologists shortly after hospital discharge. We sought to evaluate the clinic’s patient population and visit content 2 years after its inception.

Methods: We performed retrospective chart review to extract demographic and clinical data for children seen from 2021-2023. Continuous variables are summarized by median, interquartile range and categorical variables by n, %.

Results: Of 208 patients referred, 46 (22%) were scheduled and 41 (89%) presented to be seen in clinic. Median age was 3.9 (1.5, 8.2) years. About half were white, non-Hispanic (20, 48%), and an interpreter assisted with 29% (12) of visits. Most patients (31, 76%) had prior medical problems. Median length of hospitalization was 4 (2, 10.5), range 1-71 days. Five patients (12%) required increased ventilatory support at discharge.

Patients were seen in clinic 42 (23, 63) days after hospital discharge. Visits resulted in changes in medical care for the majority of patients: medications were changed for 31 (75%); new referrals (e.g., allergy/immunology, otolaryngology) were made for 23 (56%); 41 diagnostic tests (e.g., pulmonary function testing, chest x-rays, labs) were ordered for 33 (72%) patients.

Conclusions: Post-ICU clinic encounters resulted in changes in care for the majority of patients, with high rates of medication changes, referrals, and tests ordered, suggesting that the clinic meets ongoing medical needs. Children seen were generally young and medically complex. High attendance rate indicates good uptake among families. Notably, referrals exceeded capacity for BCH pulmonary post-ICU clinic visits. Thus we have increased clinic capacity and session number. Revised referral guidelines prioritize patients with prolonged hospitalizations and risk factors for recurrent respiratory failure. We are developing a multi-disciplinary expansion to address physical and psychosocial needs of patients and caregivers.

*Rabinowitz and Whitney contributed equally to this work.