P0528 - Can You Hear My Empathy? Rapid Implementation of a Pediatric Palliative Care Virtual Visit Initiative during the COVID-19 Pandemic

Background: Physical distancing required during the COVID-19 pandemic mandated a sudden need to adapt our usual practices for palliative care patient encounters. Adopting virtual visits (VV) may present challenges in managing new technology, establishing rapport, discussing difficult topics, and may diminish patient, family and clinician satisfaction. Problem statement: Pediatric palliative care clinicians have never performed virtual visits. We worry that this mode of health care delivery would negatively impact care quality and patient and family satisfaction.

Aim: By June 1, 2020, we aim to have patient/family and clinician satisfaction score of > 4 on a 5-point Likert scale for >80% of completed VV encounters.


Methodology: This project was granted IRB exemption. We used the model for improvement to ask the following questions:
What are we trying to accomplish? Shift of inpatient and outpatient workflow to include VV.
How we will know a change is an improvement? Family and clinician satisfaction surveys.
What change can we make that will result in improvement: Several changes were considered and summarized in our Key Drive Diagram (KDD) (Fig 1).
Measures: We measured family satisfaction score by asking “How well did this visit meet your care needs compared to an in-person visit?” with responses on a 5-item Likert scale. We measured clinician satisfaction with an identically modeled survey. In later PDSA cycles, we gathered qualitative data from families and clinicians. The response rates to family and provider satisfaction surveys were used as the process measure; balance measures were RVU collected for virtual visits and assessment of staff satisfaction with VV workflow.

Discussion: We adopted weekly PDSA cycles. Given the need for a rapid shift in care delivery, interventions to set up technology and train staff on use of technology were made prior to obtaining family feedback. Interventions are summarized in KDD (Figure 1). At the end of three PDSA cycles, 33% of families and 63% of all providers responded to surveys. 100% of families and 57% of clinicians rated VV as equivalent in quality to in-person visits. Qualitative feedback from clinicians indicated greater emotional toll and increased fatigue with VV. We plan to report data over a six-month period as both inpatient and outpatient palliative care VV continue.

Conclusions/Next Steps: We have demonstrated the ability to rapidly adapt palliative care visits to a virtual platform while maintaining patient and family satisfaction when compared to in-person visits. As in-person visits again become possible, we will continue to survey clinicians and families to better compare satisfaction between the two visit types and develop a sustainable workflow integrating effective VV.