The composition of pediatric care teams will naturally vary depending on the nature of the child’s medical problem and the settings and kinds of services needed. The resources, traditions, and philosophy of the employing organization may also influence team composition. In general, however, the core of an inpatient team caring for a seriously ill or injured child includes a primary subspecialist physician (e.g., pediatric oncologist or cardiologist), one or more nurse specialists, a psychologist or social worker, perhaps one or more residents or fellows, and possibly a child-life specialist. Other subpecialists (potentially, but at present rarely, including a palliative care specialist) are brought in as needed. Supporting members of the team may include pharmacists, respiratory therapists, physical therapists, genetic counselors, dieticians, and chaplains.

Team care is widely viewed as central to inpatient palliative care and home hospice programs for both adults and children and their families. To the extent that inpatient palliative care teams exist in either adult or pediatric care, they generally serve as consultants to other specialty care teams (e.g., oncology, cardiology, nephrology) that retain primary responsibility for a patient’s care, especially for children who are continuing to receive curative or life-prolonging therapies. The core of an inpatient consulting team may be nurses supported by a physician who is involved as needed. If the focus of care is primarily palliative and home based and if pediatric hospice services are available in the community and accepted by the parents, a home hospice care team may assume primary responsibility for care of the child and family. Again, nurses usually play a central role in hospice care teams.

When a child goes home for care that is primarily palliative, some families may prefer that the child’s oncology or other care team continue to take the lead, especially if the child and family are local. Geographic distance can, however, make this approach to home care impractical, and some families may prefer to have the child’s general pediatrician or family practitioner assume primary responsibility for the care of a child at home. As noted earlier, managed care rules may require such a transfer of responsibility if the focus of care shifts from cure or life prolongation to palliation.

Despite their seeming ubiquity, little systematic research appears to have focused on the numbers, structure, or performance of different kinds of pediatric care teams.7 Given (as reported below) the limited number of

7  

Team care is often a part of a multi-element intervention in which the individual elements or processes of care are not evaluated separately. Some relevant research may be categorized under “key words” that involve related concepts such as “care coordination.” For example, some research has examined the contributions or acceptance of specific professionals (e.g., nurse practitioners, social workers) in different environments (see, e.g., Burl et al., 1994; Inati et al., 1994; Aquilino et al., 1999; Dechairo-Marino et al., 2001). Team care is often associated with the use of formal clinical practice guidelines and quality improvement initiatives to



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement