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Quality Improvement/Patient Safety: Subspecialty-specific QI: see specialties above

QI 5: Quality Measures, Family Centered & Inpatient QI

250 - Implementation of a Standardized Transition Process for Pediatric Patients Enrolling into a Home-Based Hospice/Palliative Care Program

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 250
Publication Number: 250.451

Will Johansen, Washington University, SAINT LOUIS, MO, United States; Carol Massmann, St. Louis Children's Hospital, St. Louis, MO, United States

Presenting Author(s)

Will Johansen, MD (he/him/his)

Assistant Professor of Pediatrics
Washington University
SAINT LOUIS, Missouri, United States

Background: Transitioning a child from an inpatient hospital setting to an outpatient setting can be a complicated endeavor, and even more so when that child has a life-limiting illness. While St. Louis offers a dedicated home-based hospice and palliative care program, best practices regarding how to standardly and seamlessly transition a child into such a program have not been established. Deficits in this transition process may lead to a wide variety of poor outcomes, including confusion regarding medications, code status and goals of care, which can impact patient experience and potentially patient safety. This poster will demonstrate how our inpatient pediatric hospice/palliative care team worked alongside a pediatric home hospice/palliative care team, using quality improvement methods to co-create and implement standardized transition process for shared patients.

Objective: The SMART Aim of the project was to increase the percentage of patients in whom a standardized transitions process was used from 0 to 80% over six months. This project had several objectives which include the following: 1)Identifying areas for improvement in communication when enrolling a pediatric patient into home-based hospice/palliative care. 2)Identifying the best use of interdisciplinary team (IDT) meeting when transitioning an inpatient hospice/palliative patient to the outpatient realm. 3)Describe the implementation of a standardized checklist for children newly enrolled into a home-based hospice/palliative care program.

Design/Methods: Following a needs-assessment analysis with IDT members of both the inpatient and outpatient pediatric hospice/palliative care teams, we created a standardized transition of care checklist. Multiple PDSA cycles were run over the course of this project which included education sessions, specific electronic medical record note creation templates, and surveys.

Results: Over a 6 month time frame, we increased the use of the checkout process from 0 to 83% and it continues to be sustained. Surveys showed that both inpatient and outpatient pediatric hospice/palliative care IDT members believed the checklist improved communication and safety amongst children newly enrolled into a home-based hospice/palliative care program.

Conclusion(s): A standardized checklist for pediatric patients enrolling into a home-based hospice/palliative care program was effective in improving communication between IDT members in both the inpatient and outpatient settings. This is an ongoing project which has been adopted by our current inpatient and outpatient pediatric hospice/palliative care teams.