TABLE 4

Qualitative Themes During Admission Interactions

ThemeSample Quotes
Resident
 Coping with distractionsResident: “Okay. And how, how often were you doing it, the albuterol? Every 4 hours. [Phone rings] okay, give me 1 second. [Resident talks on phone for 2 min 22 s].”
Resident: “Okay, um, let’s see. Are you feeling any better? Yeah?”
Parent: “She can’t [have] no juice or nothing? Huh? You still on the phone? Are you listening? She really can’t have no juice or nothing?”
 Use of medical jargonResident: “We can try and wean, um, and slowly progress, um, off the BiPAP. We’ll probably go to high-flow nasal cannula, for now, NPO.”
 Lack of response to parental emotionsParent: “It’s horrible. We were literally in this room last year fighting low blood pressures…and she was throwing up, and it was horrible to watch.”
Resident: “Yeah okay. …She needs 2 times maintenance fluids when she’s in the hospital.”
NP, fellow, and attending
 Alignment with parental valuesParent: “They have to sedate to do the MRI. I really, really don’t like using propofol in her. ...It’s important to me that she’s comfortable and safe.”
Attending: “With her mitochondrial disease, yeah. We want the safest option for her, too. There are tons of medications we could do instead. We could do Versed, we could do Precedex...”
 Medical prognosticationNP: “So God forbid we go the other way. …But there’s nowhere else to go from this mask except for to intubate.”
 Care coordinationAttending: “I’ve talked to X, I’ve talked to Y, and I’ve talked to Z, so I’ve gotten the whole picture.”
 Response to parental emotionsParent: “If he doesn’t have it, then basically we’re just going to be living here until he can get his insulin now. …It’s just frustrating.”
Fellow: “I’m sorry you’re dealing with this.”
Parent: “Don’t apologize. I know it’s the insurance company.”
Fellow: “I'm sorry that you’re going through this though.”
Parent: “I know; I understand. I’m hoping he’ll be feeling better soon.”
  • BiPAP, bilevel positive airway pressure; NPO, nothing by mouth.