199 - Improving the Utilization of Palliative Care Consultation in the Neonatal Intensive Care Unit

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 199
Publication Number: 199.439

Emily Rosenstein, Children's National Hospital, North Bethesda, MD, United States; Janice L. Wilson, University of Maryland School of Nursing, Baltimore, MD, United States; Sofia I. Perazzo, Childrens National Hospitla, Washington, DC, United States

Presenting Author(s)

Emily Rosenstein, RNC-NIC, DNP Candidate (she/her/hers)

DNP-NNP Student
Children's National Hospital
Washington, District of Columbia, United States

Background: Perinatal palliative care provides comprehensive, interdisciplinary, and planned care for life-limiting or chronic, critical conditions throughout pregnancy and the postnatal period. The utilization of palliative care services for neonates remains limited within neonatal intensive care units despite endorsement by the American Academy of Pediatrics and the National Association of Neonatal Nurses.

Objective: To increase the use of early palliative care consults for eligible patients in a neonatal intensive care unit from 33% to 100% by December 10, 2022.

Design/Methods: As part of a quality improvement project in a Level IV neonatal intensive care unit, eligibility criteria were standardized and a trigger list of diagnostic, prenatal referral, and chronicity criteria were implemented. Interventions to improve consult compliance included staff education, redesigned workflow for consult consideration, and the use of bedside rounding to identify eligible patients. De-identified patient data was collected by manual chart audits. Education data was collected by clinician surveys and attendance at educational training sessions. Percent compliance was analyzed with a run chart to identify special-cause variation.

Results: Median palliative care consult compliance for eligible patients in the eleven weeks before project implementation was 33%. A center line shift happened after the interventions were implemented, reaching 100% compliance for those that met the eligibility criteria on October 1, 2022. Palliative care consult ordering compliance was maintained at 100% for 10 weeks until December 10, 2022 upon project cycle conclusion. Seventeen patients met inclusion criteria after go-live and consults were ordered for 16 patients (94%). Eight of the 17 patients (47%) met diagnostic, six (35%) met chronicity, and three (18%) met prenatal referral criteria. The median time from admission to palliative care consult order entry reduced from 40 to 15.5 days after implementation for eligible patients. Educational training was received by 98% of the 49 site healthcare providers.

Conclusion(s): These results indicate that quality improvement methodology successfully improved early palliative care consult ordering within one neonatal intensive care unit. Standardization of perinatal palliative care eligibility and personnel education increased the use of these services. Further research is needed to explore expanding the trigger criteria to additional diagnoses and evaluate the impact on family experiences.