Trigger Criteria to Increase Appropriate Palliative Care Consultation in the Neonatal Intensive Care Unit

Area of Science:

• Neonatal Intensive Care Unit (NICU) care
• Pediatric Palliative Care (PPC)
• Quality Improvement Methodologies

Background:

• Pediatric palliative care (PPC) is crucial for infants with life-threatening conditions, yet its integration into Neonatal Intensive Care Units (NICUs) is not routine.
• A significant number of pediatric deaths occur within the first year of life, particularly in the NICU setting.
• This study aimed to enhance PPC presence in a NICU for neonates with life-limiting diagnoses.

Purpose of the Study:

• To increase the utilization of pediatric palliative care (PPC) consultations for neonates with severe, life-limiting conditions within a Neonatal Intensive Care Unit (NICU).
• To implement and evaluate a quality improvement initiative focused on improving PPC referrals in the NICU.
• To establish a sustainable model for PPC integration in neonatal care.

Main Methods:

• Development and implementation of a trigger list identifying neonates eligible for PPC consultation.
• Interventions included collaborative trigger list creation, staff education, and program expansion.
• Quality improvement techniques were employed to drive the initiative.

Main Results:

• Over two years, 31 prenatal and postnatal patients were identified as eligible for PPC consultation via the trigger list.
• PPC consultation was provided to 24 of the 31 eligible patients.
• The project successfully increased PPC consultations from a baseline of 25% to 100% compliance within 12 months, exceeding the 80% target.

Conclusions:

• Quality improvement methodologies effectively addressed underutilization of PPC in the NICU.
• A trigger list system proved successful in increasing PPC referrals for neonates with severe diagnoses.
• This approach offers a replicable model for enhancing palliative care services in other healthcare systems.