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A Retrospective Review of Resuscitation Planning at a Children's Hospital
Jean Kelly1, Jo Ritchie2, Leigh Donovan3,4
1Paediatric Palliative Care Service, Division of Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia. jean.kelly@health.qld.gov.au.
Insights
Resuscitation plans (RP) for children with life-limiting conditions are crucial. This study found RPs influenced by condition and care setting, with palliative care involvement improving end-of-life outcomes.
Area of Science:
- Pediatric critical care medicine
- Palliative care
- End-of-life care planning
Background:
- Resuscitation plans (RP) are vital for end-of-life care in pediatrics.
- Understanding factors influencing RP development is essential for patient-centered care.
Purpose of the Study:
- To investigate the characteristics and documentation of resuscitation plans in pediatric patients.
- To analyze the influence of underlying conditions and care settings on RP development.
- To examine the impact of pediatric palliative care (PPC) services on end-of-life care outcomes.
Main Methods:
- Retrospective review of medical records of children who died in 2011 at a tertiary pediatric hospital.
- Analysis of 62 available records, focusing on documented resuscitation plans, underlying conditions, and care settings.
Main Results:
- 65% of patients had life-limiting conditions; 69% had documented RPs.
- RP development was influenced by condition type (life-limiting vs. life-threatening) and care setting (PICU vs. home).
- Patients referred to PPC had longer intervals from RP to death and were more likely to die at home.
Conclusions:
- Resuscitation plan documentation and accessibility require improvement for better patient and family-centered care.
- Inter-professional collaboration between PICU and PPC is crucial for managing end-of-life care scenarios.
- Care setting and patient condition significantly impact resuscitation planning and end-of-life outcomes.
Abstract:
Resuscitation plans (RP) are an important clinical indicator relating to care at the end of life in paediatrics. A retrospective review of the medical records of children who had been referred to the Royal Children's Hospital, Brisbane, Australia who died in the calendar year 2011 was performed. Of 62 records available, 40 patients (65%) had a life limiting condition and 43 medical records (69%) contained a documented RP. This study demonstrated that both the underlying condition (life-limiting or life-threatening) and the setting of care (Pediatric Intensive Care Unit or home) influenced the development of resuscitation plans. Patients referred to the paediatric palliative care (PPC) service had a significantly longer time interval from documentation of a resuscitation plan to death and were more likely to die at home. All of the patients who died in the paediatric intensive care unit (PICU) had a RP that was documented within the last 48 h of life. Most RPs were not easy to locate. Documentation of discussions related to resuscitation planning should accommodate patient and family centered care based on individual needs. With varied diagnoses and settings of care, it is important that there is inter-professional collaboration, particularly involving PICU and PPC services, in developing protocols of how to manage this difficult but inevitable clinical scenario.