393 - Increasing palliative care consults for extremely low birth weight infants utilizing education opt-out technology

Poster Number: 393
Publication Number: 393.435

Giulia M. Faison, Loma Linda University Children's Hospital, LOMA LINDA, CA, United States; Gina Mohr, Loma Linda University Children's Hospital, Loma Linda, CA, United States

Background: Palliative care (PC) is grossly underutilized in the neonatal population. PC can increase the quality of life for infants and their families, optimize a family-centered care approach and help assure that the care plan aligns with the goals of care of the family, improve communication between families and the primary medical team, and increase continuity across various care sites. Additionally, patients with PC consults (PCC) can further benefit the medical team via increased support and management of ongoing moral distress. The American Academy of Pediatrics (AAP) section of pediatric palliative care and hospice care (PPC-PHC) recommends that all large health care organizations serving children with life-threatening conditions or inevitably life-shortening conditions have dedicated interdisciplinary PPC-PHC teams. Numerous studies have suggested that using a trigger tool to help identify patients who could benefit from palliative care helps to increase PCC.

Objective: This study aims to increase palliative care consults for infants ≤30 weeks of gestational age or ≤1000 grams at our institution to 90% within 3 months of intervention and sustain this for a minimum of 6 months by conducting education and using an opt-out PCC order included within the admission order set upon admission.

Design/Methods: In this quality improvement study, presence of a PCC order was extracted from the electronic medical record for infants meeting the above criteria from 10/2017 to 10/2021. Frequency of PCC was calculated monthly. The first intervention consisted of providing educational materials to neonatal staff via oral presentation and newsletter publication in 07/2020. The second intervention was insertion of a pre-checked PCC placed within the admission order set in 10/2020.

Results: 434 infants met the criteria for the study. Frequency of PCC was assessed in 293 patients prior to educational intervention, which was in 33 (11.3%) of patients. After the first intervention, the frequency increased to 45% (14/31). After the second intervention, the overall frequency of PCC orders increased to 83.6% (92/110). In the most recent 9 months, the order was placed in 90% (81/90) of patients.Conclusion(s): Educational events and technology use improved PCC order placement, which is the first step towards the further growth of a dedicated interdisciplinary pediatric PC team at our institution. Future studies exploring the reasons for opting-out of the PCC order will help determine how to further increase the provision of PC. In addition, this approach can be expanded to other neonatal populations that could benefit from PCC.
Neonatology fellow and budding clinical ethicist, with a passion for neonatal palliative careProfile on Giulia36.pdf