P0547 - Inpatient Pediatric Palliative Care Consult Requests and Recommendations

Background/Purpose: Pediatric palliative care (PPC) is the comprehensive care of children with life-limiting illness. Recently, the number of PPC programs has grown drastically, and most offer an inpatient consultative service throughout the hospital with a focus on improving quality of life (QOL). However, research is limited on inpatient PPC consults and the differences between ward and intensive care unit (ICU) consults. Such research may guide improvements to these services and the QOL of patients and families. Our aims were: 1) To characterize patients receiving inpatient PPC consults and 2) to compare consult requests and recommendations by patient location (ward vs ICU) and patient type (new vs established (≥ 1 prior PPC consult)) at a tertiary care children’s hospital.

Methods: This is a single-center, retrospective, observational cohort study of children ages 0-18 years who received a full inpatient PPC consult between 1/1/2018 and 6/30/2019.

Auto-extracted data included demographics and clinical characteristics. Three study team members performed chart review to categorize consult requests and recommendations using a manual extraction tool that was designed and modified with input from our PPC team. Analysis consisted of descriptive statistics, including Wilcoxon Rank Sum, Chi-Squared, and Fisher’s Exact Tests, to compare consult requests and recommendations by patient location and type.

Results: To date, analysis of 34 patients (median age 4 years, 68.8% female, 80.6% White, and 33.3% from rural areas) revealed that all patients had at least one complex chronic condition (CCC) and more than half were technology dependent (58.8%). 19 consults (59.4%) were placed by ward teams, but 79.4% of children had an ICU stay during admission. Median length of stay prior to consult was not significant between ward and ICU patients (4 and 7 days, p=0.247) (Table 1). 61.8% of patients were new. Prior PPC consult was more common for ward vs ICU patients (p=0.002). The most common reasons for consult were not significantly different by patient location or type. Pain and respiratory distress were among the most common symptoms addressed overall. Mood was commonly addressed on the ward which differed from the ICU (p=0.004).

Conclusion: Though preliminary, our data suggests that PPC consults could occur earlier and more often in ICUs and could target patients with technology dependence. Symptoms of respiratory distress were more prevalent than nausea and fatigue which diverges from the literature. This data provides a basis to explore barriers to and interventions for earlier, more focused PPC and thus improved QOL.