Increasing Pediatric Palliative Care Consultation for Patients with Heart Disease and Prolonged Cardiac Intensive Care Stay

TL;DR

This study shows that quality improvement strategies like digital prompts and team huddles can significantly boost pediatric palliative care consultations for heart disease patients in intensive care.

Contribution

The study introduces effective QI interventions to increase PPC consultations in medically complex pediatric heart patients.

Findings

PPC consultation rates increased from 35% to 63% after implementing QI interventions.

Survey results showed positive perceptions of PPC involvement from families and CICU team members.

Collaborative huddles and digital prompts were key to improving consultation rates.

Abstract

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.

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.

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) (P < 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.

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.

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