loading page

A quality improvement project to increase palliative care team involvement in pediatric oncology patients
  • +5
  • Sana Farooki,
  • Oluwaseun Olaiya,
  • Lisa Tarbell,
  • Nicholas Clark,
  • Jennifer Linebarger,
  • John Stroh,
  • Kelstan Ellis,
  • Karen Lewing
Sana Farooki
Children's Mercy Hospitals and Clinics
Author Profile
Oluwaseun Olaiya
Children's Mercy Hospitals and Clinics
Author Profile
Lisa Tarbell
Children's Mercy Hospitals and Clinics
Author Profile
Nicholas Clark
Children's Mercy Hospitals and Clinics
Author Profile
Jennifer Linebarger
Children's Mercy Hospitals and Clinics
Author Profile
John Stroh
Children's Mercy Hospitals and Clinics
Author Profile
Kelstan Ellis
Children's Mercy Hospitals and Clinics
Author Profile
Karen Lewing
Children's Mercy Hospitals and Clinics
Author Profile

Abstract

Background: Pediatric palliative care (PPC) for oncology patients improves quality of life and the likelihood of goal-concordant care. However, barriers to involvement exist. Objectives: We aimed to increase days between PPC consult and death for patients with refractory cancer from a baseline median of 13.5 days to ≥30 days between March 2019 and March 2020. Methods: Outcome measure was days from PPC consult to death; process measure was days from diagnosis to PPC consult. The project team surveyed oncologists to identify barriers. Plan-Do-Study-Act cycles included establishing target diagnoses, offering education, standardizing documentation, and sending reminders. Results: The 24-month baseline period included 30 patients that died and 25 newly diagnosed patients. The yearlong intervention period included 6 patients that died and 16 newly diagnosed patients. Interventions improved outcome and process measures. Targeted patients receiving PPC ≥ 30 days prior to death increased from 43% to 100%; median days from consult to death increased from 13.5 to 159.5. Targeted patients receiving PPC within 30 days of diagnosis increased from 28% to 63%; median days from diagnosis to consult decreased from 221.5 to 14. Of those without PPC consult within 30 days after diagnosis, 17% had template documentation of the rationale. Conclusion: Interventions utilized met the global aim, outcome and process measures. Use of QI methodology empowered providers to involve PPC. Poor template use was a barrier to identifying further drivers. Future directions for this project relate to expanding the target list, creating long-term sustainability, formalizing standards, and surveying patients and families.

Peer review status:IN REVISION

30 Jun 2020Submitted to Pediatric Blood & Cancer
30 Jun 2020Assigned to Editor
30 Jun 2020Submission Checks Completed
15 Jul 2020Reviewer(s) Assigned
22 Jul 2020Review(s) Completed, Editorial Evaluation Pending
22 Jul 2020Editorial Decision: Revise Major