P0552 - Leading The Witness: Pediatric Palliative Program Improvement Through Instructional Investigation

Background:

Palliative Care consultation can often be limited primarily to the practice areas of those staffing the program. In Pediatrics, this is further complicated by the difficulties of prognostication in chronically-ill children and confusion surrounding the purpose of Palliative Care in a non-terminal but seriously ill child. Quality Improvement initiatives that are limited to directive interventions, such as consult triggers or structured educational offerings, can often be viewed as invasive or presumptuous by colleagues that see palliative practice as part of their own specialty. In these circumstances, we have found that a Quality Improvement project, in the form of a survey with directed questions and included, brief Palliative education, allowed for the collection of initial program data while also facilitating Palliative Care understanding and future utilization.

Methodology

A survey was designed which included quantitative items on a 7-Point Likert scale related to likelihood of Pediatric Palliative consult in various clinical situations as well as qualitative items allowing for the interviewer to record impressions and reasoning behind the quantitative scores. Next, a small instructional passage was included to allow for education of interviewee on multiple cases for Palliative involvement related to various patient vignettes. Finally, a following section held more quantitative and qualitative prompts, this time relating to new ways to involve Pediatric Palliative Care - thus facilitating brainstorming between the interviewer and interviewee on steps leading to new Palliative consults. Participants were Pediatric Attending and were chosen from units around the Pediatric hospital that have consulted Palliative Care in the past. A follow-up survey was done three months later to reassess actions and attitudes surrounding Pediatric Palliative Care which was similar in form to the initial section of the previous survey. Data on new consults was also tracked during this time to report alongside the survey data.

Discussion

Attendings surveyed for their perceptions and patterns of Palliative Care utilization showed consistency within specialty and variability between specialties. This was as anticipated, as Palliative providers hypothesized that individual units had their own unique views of what Palliative Care offers and which patients are most appropriate for Palliative Care. On open-ended questioning, interviewees often noted an uncertainty about the proper time to involve Pediatric Palliative Care owing to the difficulty of Pediatric prognosis. Somewhat surprisingly, after further Palliative Care education, a majority of staff members identified several items with which that they did not realize Palliative Care could help. A follow-up survey at 3 months showed a much more well-rounded view of Palliative Care practice as well as a significant increase in consultations.

Conclusion

A combined Quality Improvement survey and Palliative Care educational intervention proved beneficial in facilitating open communication between specialties and improved both perception of Palliative Care and appropriate consultation.