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Abstract

Introduction: The American Academy of Pediatrics recommends that a pediatric palliative care (PC) team consist of "a physician, nurse, social worker, spiritual advisor, and child life therapist". It is unknown how many PC teams include these members or whether the design of a PC team affects the numbers of PC referrals. Methods: We designed and tested a survey tool to capture PC team composition. The survey was sent electronically using Research Electronic Data Capture (REDCap), hosted at the University of Utah, to PC team directors at 44 pediatric hospitals that contribute to the Pediatric Health Information Systems (PHIS) database. The survey was sent to a hospital administrator if the hospital did not have a PC team. Survey results were analyzed using descriptive statistics. In order to index PC referrals to hospital capacity, we calculated PC referrals by number of referrals per hospital bed in the year 2012 and compared this index to reported team composition. Results: Survey response rate was 86% (38/44). The majority of responders were from hospitals with PC teams (35/38, 92%). The mean estimated PC referrals in 2012, were 135 (range 12-337). The mean referrals per hospital bed for 2012, was 0.46 (range 0.05-2.13). The mean number of PC team members was 4.1 with a range from ≤ 1 full time team member to over 9. Neither PC team member types nor the total number of PC team members (pearson correlation=0.184) were significantly associated with indexed referrals. However, having certain types of team members, specifically acute pain service (APS), chronic pain service (CPS), and advanced nurse practitioners (ANP), tended to increase the mean indexed referrals, [APS: 0.65 vs. 0.43 (p=0.36), CPS: 0.67 vs. 0.43 (p=0.45), and APN: 0.53 vs. 0.32 (p=.07)]. Interestingly, the presence of a physician who identified themselves as Hospice and Palliative Medicine (HPM) also tended to increase the mean number of indexed referrals [0.52 vs. 0.39 (p=0.34)], however, this was not significant. Conclusions: Overall, neither the type of team member nor the number of members on a PC team significantly affected indexed referral numbers. However, certain members like ANPs may increase referrals.