Introduction of Triggers for Palliative Care Consultation Improve Utilization and Satisfaction within a Level IV NICU (SA508D)

Abstract

•Identify three key elements that influence successful implementation of triggers for palliative care consultation within a NICU setting.•Recall the four major trigger domains that qualify for pediatric palliative care consultation within a NICU setting. The use of a palliative care guideline, such as a trigger list for palliative care consultation (PCC), remains controversial in the NICU. Despite knowledge that a palliative team is present at our institution, the level of utilization of their services, and the NICU providers’ attitudes and beliefs regarding neonatal palliative care, are unknown. We sought to increase awareness of the palliative care team’s role and the criteria in which a consultation is appropriate, with a SMART aim to increase the number of PCCs within our level four NICU by 20% by the end of December 2016. The setting is in a Level four NICU at an academic urban pediatric hospital. The study design included observational time series with multiple planned sequential interventions, which include but not limited to surveys and education. Medical chart review screened for eligibility for PCC. Statistical process control charts show performance over time. Many providers noted a need for a guideline for PCC. Prior to implementation of the triggers, of those who qualified for PCC, 26% received consultation, which increased to 46% after implementation. There was also an increase in the percentage of survey respondents who understand what the team's role is, know when they should be consulted, and noticed a positive difference since their utilization. Lastly, the time until initial consultation decreased from approximately 1.5 months to one week. We achieved our goal of increasing the number of PCC by 20%, and decreased time to initial consultation. The triggers helped establish prompt and proactive referral. Not only can a written guideline increase awareness of a palliative care team’s role within a NICU, but it also enhances the satisfaction amongst providers of the care they are giving. Early integration of palliative care within the NICU can help guide revision of treatment goals, improve communication, and provide continuity of comprehensive care to families.