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Updated: Jan 7, 2026

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A Quality Improvement Approach to Perinatal Palliative Care: Using Standardized Criteria and Education to Increase

Emily Rosenstein1, Jan Wilson, Sofia Perazzo

  • 1Author Affiliations: Department of Neonatology, Children's National Hospital, USA (Drs Rosenstein and Perazzo); University of Maryland School of Nursing, USA (Dr Wilson); and Department of Pediatrics, George Washington University School of Medicine and Health Sciences, USA (Dr Perazzo).

Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses
|December 31, 2025
PubMed

Insights

Implementing standardized criteria and education significantly improved perinatal palliative care (PC) consults for infants in a neonatal intensive care unit (NICU). This enhanced care quality for high-risk infants and their families.

Area of Science:

  • Neonatal Intensive Care Unit (NICU) Care
  • Palliative Care (PC)
  • Quality Improvement Projects

Background:

  • Perinatal palliative care (PC) is crucial for infants with life-limiting conditions.
  • Underutilization of PC services in a Level IV NICU impacted care quality for infants and families.

Purpose of the Study:

  • To increase early PC consults for eligible NICU infants from 33% to 100% between August and December 2022.
  • Enhance the quality of care for infants with chronic critical conditions.

Main Methods:

  • Utilized the Promoting Action on Research Implementation in Health Services (PARIHS) framework.
  • Implemented standardized diagnostics, prenatal referrals, and eligibility criteria in one NICU.
  • Measured PC consult ordering compliance and provider education effectiveness.

Main Results:

  • PC consult ordering compliance increased from 33% to 100% within two weeks and was sustained.
  • Time from NICU admission to PC consult order decreased from 40 to 15.5 days.
  • Provider education improved clinician comfort in identifying eligible infants (Z=3.02, P=.003).

Conclusions:

  • Standardized eligibility criteria and staff education effectively improved early PC consult ordering in the NICU.
  • This quality improvement initiative enhanced care delivery for critically ill infants and their families.
Abstract

Keywords:
guidelineneonatalpalliative careprotocolquality improvementreferral criteriatrigger

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