Implementing Early Pediatric Palliative Care for Patients in the Pediatric Intensive Care Unit (QI837)

Abstract

•Create a standardized criteria for pediatric palliative care consultation using a systemic approach.•Discuss the need of a formal Palliative consult to be discussed daily in interprofessional rounds. The number of palliative care consults prior to standardized criteria was low and goal was to change practice and culture to increase number of consults and improve timing. The interprofessional team reviewed CAPC criteria and added additional criteria based on population needs in the PICU. The purpose of this quality improvement project was to develop a structured process to identify patients who would most benefit from early palliative care. Interventions included developing standardized criteria for pediatric palliative care consultation using a systemic approach, providing nursing and provider education regarding the new process and criteria, the importance of palliative care, and addition of palliative consultation to the PICU admission order set and daily rounding checklist. A single center retrospective chart review from January 2014 through December 2016 was completed. Criteria were evaluated to see if it was used for the intended patients, if consults were generated, and if there were any measurable outcomes. Specific attention to if the interventions decreased the length of time between admission to the PICU to placement of palliative consultation as well as volume of consultation. During the evaluation period the consultation rate increased from 3.5% to 13% of patients seen in PICU and the time between PICU admission and palliative care consultation decreased from approximately 10 days to 3.5 days. While Initial data looks promising, with the increasing number of consults and the decreased time frame from PICU admission to placement of consult, further assessment is necessary to assess effectiveness and sustainably of palliative care criteria. Data will continue to be collected and assessed through 2017.