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Quality indicators for paediatric palliative care
Janie Charlebois1, Claude Cyr1
1Département de pédiatrie, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Quebec.
Insights
Paediatric palliative care quality indicators showed unsatisfactory performance in children with chronic complex conditions (CCCs). Improvements are needed in timely goal-of-care discussions and bereavement follow-up for better quality of life.
Area of Science:
- Pediatric Palliative Care
- Quality Improvement Science
- Healthcare Management
Background:
- Paediatric palliative care (PPC) is crucial for children with chronic complex conditions (CCCs).
- Evaluating PPC quality is essential for identifying areas needing improvement.
- Current quality indicators for PPC require rigorous assessment in clinical settings.
Purpose of the Study:
- To implement and assess performance against specific quality indicators for paediatric palliative care.
- To evaluate the effectiveness of current PPC service provision in a university medical centre.
Main Methods:
- Medical records of 50 children with CCCs (2006-2011) were reviewed.
- Quality indicators focused on end-of-life care, goal-of-care discussions, procedures, and bereavement follow-up.
- Data analysis assessed performance metrics against established benchmarks.
Main Results:
- Only 60% of patients had timely goals-of-care discussions.
- 44% underwent invasive procedures in their final month; only 50% received bereavement follow-up.
- Palliative care involvement was linked to fewer invasive procedures and better documentation of preferred place of death.
Conclusions:
- Performance on key PPC quality indicators was unsatisfactory for children with CCCs.
- Significant opportunities exist to enhance the quality of paediatric palliative care.
- Implementing strategies from other paediatric care quality improvements, such as interdisciplinary teamwork, is recommended.
Objectives:
To apply quality indicators for paediatric palliative care and evaluate performance in one service provision area.
Methods:
After institutional review board approval, medical records were abstracted for well-defined and measurable quality indicators for children with chronic complex conditions (CCCs) between January 2006 and December 2011 (n=50) at a university medical centre.
Results:
Of the 50 children with a CCC (mean age 64 months, 48% female), 39 (78%) died in hospital, 11 (22%) died at home and 13 (26%) were <1 month of age. In the final month of their life, 10 patients (20%) required an unplanned visit to the emergency department and seven (14%) were admitted. Only four patients (8%) were admitted for >14 days in their final month of life. Goals of care were addressed in a timely manner 60% of the time. An invasive procedure was performed in the final month of life in 27 (44%) patients. Bereavement follow-up was offered to 25 (50%) families. A palliative care consultant was involved with 17 (34%) patients. Palliative care was associated with less frequent invasive procedures in the final month of life and more frequent documentation of the preferred place of death.
Conclusion:
Performance on these particular quality indicators was unsatisfactory across a diverse group of children with CCCs, indicating important opportunities for improvement. Methods used to improve the quality of other aspects of paediatric care, including emphasis on efficient work systems, practical tools and interdisciplinary teamwork, should be used for ensuring delivery of high-quality palliative care.
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