Implementation of an innovative palliative care screening tool in the picu

Introduction: Pediatric palliative care (PPC) has been shown to improve the care of seriously-ill patients and their families. Early referral to PPC for children requiring the pediatric intensive care unit (PICU) is recommended. While there are published screening tools to identify patients who may benefit from PPC involvement, these tools are time-consuming and challenging to integrate into the PICU workflow. The purpose of this study is to evaluate whether use of a brief weekly screening tool increases the number of PPC consults placed during PICU admission. Methods: This was a prospective investigational single center study in an 18-bed tertiary care center PICU. A 7-question screen based on the existing validated Paediatric Palliative Screening scale (PaPaS) was developed by the PICU and PPC teams. The screen was completed by two PICU attendings once per week over the course of 13 weeks. Demographic, therapeutic, and diagnostic data was collected at the time of screening. Results: Eighty-nine screens were completed on 69 individual patients, resulting in 54 negative screens and 35 positive screens. Eight PPC consults were placed from the PICU during this 13-week period; 4 of these patients were identified solely based on the screening tool. During the 13 weeks preceding initiation of the screening tool, 4 PPC consults were placed from the PICU. There was no difference in age, sex, race, or ethnicity between patients that screened positive and those that screened negative. Of patients that screened positive, 30 (86%) had 2 or more comorbidities at PICU admission compared to 12 (22%) of those who screened negative, p< 0.001. Neurological (n=26, 74%) and respiratory (n=27, 77%) comorbidities and technology dependence (n=26, 74%) were most common in positive screens. There was no difference in number of intubations (n=15, 43% vs. n=26, 48%, p=0.668) between positive and negative screens, but mean length of mechanical ventilation was longer for positive screens (5.54 (SD 4.15) vs. 2.83 (SD 3.01) days, p< 0.001). There was 100% concordance between the 2 screeners in identifying positive and negative screens. Conclusions: Use of a brief screening tool can identify patients who may benefit from PPC referral and increase the number of PPC consults placed during PICU admission.