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The Effect of Palliative Care Team Design on Referrals to Pediatric Palliative Care

Linda Keele1, Heather T Keenan2, Susan L Bratton2

  • 11 Department of Anesthesia and Critical Care, Valley Children's Hospital , Fresno, California.

Journal of Palliative Medicine
|December 17, 2015
PubMed

Insights

Pediatric palliative care (PC) team composition and availability do not significantly impact patient utilization. However, adding advanced nurse practitioners and pain or hospice specialists may increase referrals.

Area of Science:

  • Pediatric Palliative Care
  • Healthcare Management
  • Clinical Operations

Background:

  • Palliative care (PC) is crucial for children with serious illnesses.
  • The American Academy of Pediatrics (AAP) and American Academy of Hospice and Palliative Medicine (AAHPM) suggest minimal standards for PC team composition.
  • The impact of PC team structure on service utilization remains unclear.

Purpose of the Study:

  • To characterize pediatric PC team composition and availability.
  • To determine if team structure and availability correlate with PC utilization.
  • To investigate patterns in PC referrals.

Main Methods:

  • A descriptive survey was conducted.
  • Participants included directors or administrators of pediatric PC teams at 44 Pediatric Health Information System (PHIS) hospitals.
  • Response rate was 86%.

Main Results:

  • Pediatric PC teams varied significantly in size (0.1 to 9 full-time members).
  • Teams with an advanced nurse practitioner (ANP) showed a trend toward higher referral rates (34% increase).
  • Teams with specialists in acute pain, chronic pain, or hospice palliative medicine also showed trends toward increased referrals, but differences were not statistically significant.

Conclusions:

  • Neither team composition nor availability appears critical for pediatric palliative care utilization.
  • Hospitals should establish formal PC teams, even with incomplete adherence to recommended standards.
  • Consider adding ANPs and pain/hospice specialists to potentially enhance PC referrals.
Abstract

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