Fellow: Sasha Wee, MD; Medical University of South Carolina
Article: Ibeziako P, Brahmbhatt K, Chapman A, De Souza C, Giles L, Gooden S, et al. Developing a Clinical Pathway for Somatic Symptom and Related Disorders in Pediatric Hospital Settings. Hospital Pediatrics. 2019;9(3):147-155.
Summary: There exists a lack of standardized care pathways for children with somatic symptom and related disorders (SSRDs) in the inpatient hospital setting. Management of children with SSRDs has been associated with higher frustration levels of both families and providers, higher healthcare utilization, interventions, and healthcare costs. The authors sought to develop a clinical pathway regarding care for children with SSRD utilizing a standardized model, written by a team of pediatric consultant-liaison psychiatrists, with feedback provided from a multidisciplinary group of stakeholders.
The pathway lists five critical steps from admission to discharge:
(1) Early recognition of potential somatization;
(2) Early interdisciplinary assessment (involving consultants from relevant specialties early in the admission);
(3) Interdisciplinary provider meeting (to achieve consensus on care plan);
Then, following confirmation of SSRD diagnosis:
(4) Interdisciplinary informing family meeting;
(5) Interdisciplinary management during patient hospitalization.
Sample scripts and handouts for management were included, including a family introductory handout outlining the plan of care, as well as scripts for introducing psychiatry and other consultations to the family, introducing measures of assessment, informing family meeting, and discussing the mind-body connection.
Key Strengths: This article provides a standardized structure for a clinical pathway that may be generalizable across multiple institutions. Through the sample scripts and handouts included, it allows providers to be empowered in navigating difficult conversations with families, and to standardize care for children with SSRDs.
Limitations: As this clinical pathway was only recently developed, testing for implementation and efficacy has not been established across multiple hospitals. Some of the resources and consultations recommended in the guideline may not be available at all hospitals. Lastly, although the pathway received feedback from an interdisciplinary group of stakeholders, they were written by providers in one discipline, pediatric consultation-liaison psychiatry.
Major Takeaway: Care for children with SSRDs can be frustrating for both providers and families. Standardizing this practice, particularly through early diagnosis of SSRD and with interdisciplinary assessment and involvement throughout the hospitalization, has a potential to decrease complications, morbidity, length of stay, and healthcare utilization for these children.
Impact on Practice: This article provides the framework for pediatric hospitalists to continue to improve the care children with SSRDs receive. It should prompt us to develop guidelines and standard practice in caring for children with SSRDs, including early diagnosis of SSRD. Early involvement of mental health professionals and an interdisciplinary team is key to the care of these children.
Article: Ibeziako P, Brahmbhatt K, Chapman A, De Souza C, Giles L, Gooden S, et al. Developing a Clinical Pathway for Somatic Symptom and Related Disorders in Pediatric Hospital Settings. Hospital Pediatrics. 2019;9(3):147-155.
Summary: There exists a lack of standardized care pathways for children with somatic symptom and related disorders (SSRDs) in the inpatient hospital setting. Management of children with SSRDs has been associated with higher frustration levels of both families and providers, higher healthcare utilization, interventions, and healthcare costs. The authors sought to develop a clinical pathway regarding care for children with SSRD utilizing a standardized model, written by a team of pediatric consultant-liaison psychiatrists, with feedback provided from a multidisciplinary group of stakeholders.
The pathway lists five critical steps from admission to discharge:
(1) Early recognition of potential somatization;
(2) Early interdisciplinary assessment (involving consultants from relevant specialties early in the admission);
(3) Interdisciplinary provider meeting (to achieve consensus on care plan);
Then, following confirmation of SSRD diagnosis:
(4) Interdisciplinary informing family meeting;
(5) Interdisciplinary management during patient hospitalization.
Sample scripts and handouts for management were included, including a family introductory handout outlining the plan of care, as well as scripts for introducing psychiatry and other consultations to the family, introducing measures of assessment, informing family meeting, and discussing the mind-body connection.
Key Strengths: This article provides a standardized structure for a clinical pathway that may be generalizable across multiple institutions. Through the sample scripts and handouts included, it allows providers to be empowered in navigating difficult conversations with families, and to standardize care for children with SSRDs.
Limitations: As this clinical pathway was only recently developed, testing for implementation and efficacy has not been established across multiple hospitals. Some of the resources and consultations recommended in the guideline may not be available at all hospitals. Lastly, although the pathway received feedback from an interdisciplinary group of stakeholders, they were written by providers in one discipline, pediatric consultation-liaison psychiatry.
Major Takeaway: Care for children with SSRDs can be frustrating for both providers and families. Standardizing this practice, particularly through early diagnosis of SSRD and with interdisciplinary assessment and involvement throughout the hospitalization, has a potential to decrease complications, morbidity, length of stay, and healthcare utilization for these children.
Impact on Practice: This article provides the framework for pediatric hospitalists to continue to improve the care children with SSRDs receive. It should prompt us to develop guidelines and standard practice in caring for children with SSRDs, including early diagnosis of SSRD. Early involvement of mental health professionals and an interdisciplinary team is key to the care of these children.