Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, USA

Jessica Turnbull, M.D., M.A. is a pediatric intensivist at the Monroe Carell Jr. Children’s Hospital at Vanderbilt, as well as a member of the faculty of the Center for Biomedical Ethics and Society at Vanderbilt Medical Center.  The project, “Implementing PICU Screening Criteria for Unmet Pediatric Palliative Care Needs” has served as a stepping-stone in the provision of seamless care for medically complex children cared for at Vanderbilt during times of illness ranging from baseline medical fragility to those requiring care in the pediatric intensive care unit.  Future projects will involve multidisciplinary work aimed at improving the lifelong family-centered medical care of children with special healthcare needs.  

(1) Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States,

(2) Vanderbilt University School of Medicine, Center for Biomedical Ethics and Society, Nashville, TN, United States

Background, context and aims: The number of children with life limiting illnesses is growing. Many children with life limiting illnesses die in the hospital. Children receiving PC at the time of death are less likely to die in the ICU. The Improving Palliative Care in the ICU (IPAL-ICU) Project provides a process to determine how PC resources may be utilized in intensive care units (ICUs). The IPAL-ICU Project has been shown to promote PC consultation in adult ICUs, but its use in a pediatric ICU (PICU) has not been reported. The aims of this study are to: 1) create screening criteria for PC consult from the IPAL-ICU Project for use in a pediatric setting and 2) revise a currently-utilized PICU bedside nurse rounding tool to include screening criteria for PC consult. The primary outcome variable is change in number of PC consults after implementation of the revised rounding tool.

Methods: Bedside nurses completed surveys assessing their perceptions of the utilization of PC consults in the PICU. Screening criteria for pediatric PC consult were created using the IPAL-ICU Project, after which the criteria were added to a rounding tool utilized by the bedside nurses. Bedside nurses then completed post-intervention surveys assessing their perceptions of the utilization of PC consults in the PICU.

Results: The average monthly number of PC consults in the PICU was 3 pre-intervention and 4 post-intervention. 79 nurses completed the pre-intervention survey and 49 completed the post-intervention survey. The perceived amount of PC involvement in the PICU increased post-intervention.

Conclusions: The IPAL-ICU Project may be used to create screening criteria for PC consultation for patients in the PICU. The described intervention improved the level of perceived involvement of the pediatric PC service in the PICU.