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Pediatric palliative care consultation services in California hospitals
Thomas Reid1, David L O'Riordan, Andrea Mazzini
11 Palliative Care Program, University of California San Francisco , California.
Insights
Pediatric palliative care services (PCS) are available in all California children's hospitals and some mixed hospitals. However, children's hospitals provide more comprehensive care for non-cancer diagnoses compared to mixed hospitals.
Area of Science:
- Pediatric Healthcare
- Palliative Care Services
- Hospital Administration
Background:
- The American Academy of Pediatrics advocates for palliative care access for critically ill hospitalized children.
- Current knowledge regarding the structural organization of pediatric palliative care services (PCS) is limited.
Purpose of the Study:
- To determine the prevalence of pediatric palliative care services (PCS) in California hospitals.
- To compare the structural characteristics of pediatric PCS with those of adult PCS.
Main Methods:
- A survey was conducted across 377 California hospitals to assess the prevalence, structure, and characteristics of both pediatric and adult PCS.
- Hospitals were classified into three groups: children's hospitals with pediatric-only PCS, mixed hospitals with both pediatric and adult PCS, and hospitals with adult-only PCS.
Main Results:
- All 8 children's hospitals reported having pediatric PCS, alongside 36 such services in mixed hospitals.
- Pediatric-only PCS in children's hospitals served significantly more children annually and managed a higher proportion of non-cancer-related illnesses compared to PCS in mixed hospitals.
- While all PCS offered weekday availability, only half provided weekend services. Pediatric-only PCS had comparable full-time equivalent (FTE) staffing to pediatric PCS in mixed hospitals, but adult PCS in mixed hospitals had significantly higher FTE than their pediatric counterparts.
Conclusions:
- Pediatric PCS are established in all California children's hospitals and some mixed-care facilities.
- Further research is needed to understand the palliative care needs of seriously ill children in mixed hospitals and to evaluate the quality of care provided, ensuring equitable access to essential services.
Background:
The American Academy of Pediatrics recommends that palliative care be available to seriously ill hospitalized children, yet little is known about how these services are structured.
Objective:
The study's aim is to report the prevalence of pediatric palliative care services (PCS) and compare the structure of pediatric PCS to adult PCS within California hospitals.
Methods:
We surveyed 377 hospitals to assess the prevalence, structure, and characteristics of pediatric and adult PCS. Hospitals were categorized as children's hospitals with a pediatric-only PCS, mixed hospitals with pediatric and adult PCS, and hospitals with adult-only PCS.
Results:
All 8 children's hospitals in the state reported having a pediatric PCS, and 36 pediatric PCSs were in mixed hospitals. Mixed hospitals saw fewer (p=0.0001) children per year (mean=5.6, standard deviation [SD]=3.6) than pediatric-only PCSs (mean=168, SD=73). Pediatric-only PCSs treated more patients for noncancer-related illness (82.5%) than pediatric PCSs in mixed hospitals (34.5%, p=0.03) or adult-only PCSs (52.4%, p=0.001). All PCSs were universally available (100%) during weekday business hours and half were available during weekend business hours. Pediatric-only PCSs had a mean total full-time equivalent (FTE) of 1.9, which was not significantly different (p=0.3) from the total FTE for pediatric PCSs in mixed hospitals (mean=1.1, SD=1.4) or for adult-only PCSs (mean=2.7, SD=2.0). However, in mixed hospitals the adult PCS had a significantly higher (p=0.005) total FTE (mean=2.4, SD=1.3) than the pediatric PCS (mean=1.1, SD=1.4).
Conclusion:
All children's hospital and a few mixed hospitals offer pediatric PCS. Better understanding of the palliative care needs of seriously ill children in mixed hospitals and assessment of the quality of care provided will help ensure that children seen in these hospitals receive necessary care.
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