Improving Prenatal Palliative Care Consultation Using Diagnostic Trigger Criteria

Matthew Lin, Division of Neonatology (M.L.), Department of Pediatrics, New York University School of Medicine, New York, New York, USA. Electronic address: matthew.lin@nyulangone.org.
Erin Rholl, Division of Neonatology (E.R.), Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Nickie Andescavage, Division of Neonatology (N.A.), Children's National Hospital, Washington, District of Columbia, USA; School of Medicine and Health Sciences (N.A., D.F., A.F.L., L.A.M.), George Washington University, Washington, District of Columbia, USA.
Olivia Ackerman, Prenatal Pediatrics Institute (O.A.), Children's National Hospital, Washington, District of Columbia, USA.
Deborah Fisher, School of Medicine and Health Sciences (N.A., D.F., A.F.L., L.A.M.), George Washington University, Washington, District of Columbia, USA; Pediatric Palliative Care Program (D.F., A.F.L., L.A.M.), Children's National Hospital, Washington, District of Columbia, USA.
Ashley F. Lanzel, School of Medicine and Health Sciences (N.A., D.F., A.F.L., L.A.M.), George Washington University, Washington, District of Columbia, USA; Pediatric Palliative Care Program (D.F., A.F.L., L.A.M.), Children's National Hospital, Washington, District of Columbia, USA.
Laila A. Mahmood, School of Medicine and Health Sciences (N.A., D.F., A.F.L., L.A.M.), George Washington University, Washington, District of Columbia, USA; Pediatric Palliative Care Program (D.F., A.F.L., L.A.M.), Children's National Hospital, Washington, District of Columbia, USA.

Document Type

Journal Article

Publication Date

10-18-2023

Journal

Journal of pain and symptom management

DOI

10.1016/j.jpainsymman.2023.10.015

Keywords

NICU; Quality Improvement; pediatric palliative care; perinatal palliative care

Abstract

BACKGROUND: Three percent of pregnancies are complicated by congenital anomalies. Prenatal integration of pediatric palliative care (PPC) may be hindered by non-standardized PPC referral processes. This quality improvement (QI) project aimed to improve prenatal PPC consultation using a diagnostic trigger list. MEASURES: Main outcome measure was the percentage of prenatal PPC consults completed based on diagnostic trigger list eligibility. Balancing measures included stakeholder perspectives on PPC consults and products. INTERVENTION: Interventions included creation and implementation of a diagnostic trigger list for prenatal PPC consultation, educational initiatives with stakeholders, and iterative modifications of our prenatal consultation process. OUTCOMES: Interventions increased consultation rates ≥80% during the first six months of QI implementation (baseline vs. post-interventions) although this increase was not consistently sustained over a 12-month period. CONCLUSIONS/LESSONS LEARNED: Diagnostic trigger lists improve initial rates of prenatal PPC consultation and additional interventions are likely needed to sustain this increase.

Department

Medicine

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