Increasing Pediatric Palliative Care Consultation for Patients with Heart Disease and Prolonged Cardiac Intensive Care Stay.
Andrew Headrick, Sarah Wawrzynski, Judson Moore, Melissa Winder, Jasmine R Masih, Michele De Leon Jauregui, Brian Flaherty, Benjamin Moresco, Morgan M Millar, Rachel R Codden, Dominic Moore, Claudia Delgado-Corcoran
Author Information
Andrew Headrick: From the Department of Pediatrics, Division of Cardiology, University of Utah at Primary Children's Hospital, Salt Lake City, Utah.
Sarah Wawrzynski: Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, De.
Judson Moore: From the Department of Pediatrics, Division of Cardiology, University of Utah at Primary Children's Hospital, Salt Lake City, Utah.
Melissa Winder: From the Department of Pediatrics, Division of Cardiology, University of Utah at Primary Children's Hospital, Salt Lake City, Utah.
Jasmine R Masih: Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Michele De Leon Jauregui: Division of Pediatric Critical Care Medicine, University of Utah, Salt Lake City, Utah.
Brian Flaherty: Division of Pediatric Critical Care Medicine, University of Utah, Salt Lake City, Utah.
Benjamin Moresco: Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Morgan M Millar: Division of Epidemiology, University of Utah, Salt Lake City, Utah.
Rachel R Codden: Division of Epidemiology, University of Utah, Salt Lake City, Utah.
Dominic Moore: Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Claudia Delgado-Corcoran: Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Introduction: Patients with congenital heart disease are medically complex and experience high rates of morbidity and mortality. Pediatric palliative care (PPC) supports families navigating complex medical scenarios. This study evaluates the effect of quality improvement (QI) interventions towards increasing PPC consultations in patients with heart disease and cardiac intensive care unit (CICU) length of stay (LOS) ≥ 14 days. Methods: We conducted a mixed methods QI study using CICU team members and family survey assessments of PPC involvement. Patients with CICU LOS ≥14 days were eligible and comprised our study cohort. Interventions included the implementation of a digital prompt screening for eligible patients sent to CICU and PPC providers, as well as the implementation of weekly huddles to discuss consulted and eligible patients. Through the pre- and postintervention phases, family members of consulted patients and CICU team members were surveyed. Results: Preintervention (January 2020 to December 2021), PPC consultation rates were 35% (n = 34) and increased to 63% (n = 43) postintervention (January 2022 to February 2023) ( < 0.01). The timing of consultation was similar between phases. Survey results from family members (n = 19, 39% of 49 participants) and CICU team members (n = 80, 40% of eligible) revealed predominantly positive perceptions regarding PPC involvement. Conclusions: QI interventions, including collaborative huddles and digital prompts based on discrete screening criteria, lead to significantly increased rates of PPC consultation in patients with heart disease in the CICU. Survey results support PPC consultation as a positive contribution for families and CICU team members.
References
J Am Heart Assoc. 2018 Nov 20;7(22):e010624
[PMID: 30571499]
