TY - JOUR
T1 - Integration of pediatric palliative care into cardiac intensive care
T2 - A champion-based model
AU - Moynihan, Katie M.
AU - Snaman, Jennifer M.
AU - Kaye, Erica C.
AU - Morrison, Wynne E.
AU - DeWitt, Aaron G.
AU - Sacks, Loren D.
AU - Thompson, Jess L.
AU - Hwang, Jennifer M.
AU - Bailey, Valerie
AU - Lafond, Deborah A.
AU - Wolfe, Joanne
AU - Blume, Elizabeth D.
N1 - Funding Information:
Multidisciplinary CICU-based PPCCs Interested clinicians receive training in communication and PC principles Three role domains: clinical, educational, and operational Encourages earlier and long-standing incorporation of PC principles into the care of children with critical cardiac disease PPCCs have extensive expertise in both cardiac medicine and PC. As integral members of the CICU interdisciplinary team, PPCCs have an improved understanding of CICU culture and team dynamics to facilitate PPC integration and create a shared mindset. Bidirectional knowledge transfer between PPCCs and PPC subspecialists can improve symptom management and care needs of the patient population both in the CICU (by PPCCs) and to wider PPC patients (through subspecialty PPC providers). Improved primary PC delivery with empowered champions providing care and education; Specialist experts and resources can be prioritized for the most complex patients and families. Extends the impact and reach of PC within the CICU, providing holistic care to a greater proportion of patients and their families. Requires institutional support and buy-in from CICU providers and support for upfront and ongoing training of PPCCs Needs a robust institutional subspecialty PPC team to support program development and training as well as PPCC provider support and mentorship There are potential challenges over recruitment and retention of PPCCs and the possibility of role confusion and/or misconception The PANDA PC Team: Panda Cubs This QI project at Children’s National involves an intensive PC educational and mentorship program for physicians, advanced practice nurses, registered nurses, and social work and child life staff, including from the CICU. The year-long program includes a 2-d course adapted from the ELNEC-PPC and EPEC-Pediatrics quarterly educational sessions, monthly rounding with discussions of case studies, and a final 1-d educational conference. Participants have mentorship and are expected to undertake a unit-based QI project to establish meaning and integrate knowledge into practice. PC in the Heart Center Department-funded training at the Boston Children’s Hospital trained 2 physicians, a cardiac intensivist and cardiologist, to complete the PCEP course with additional support to undertake rotations with the subspecialty PPC services to augment primary PC delivery in the heart center. An interdisciplinary communication and PC working group was created to better understand obstacles and implement solutions to the complex decision-making and communication surrounding the care of children with advanced heart disease, with research including parent, physician, and nursing surveys on symptom burden, prognostic awareness and communication, and a monthly journal club PC interest group. Mid-career PC Training Program This educational pilot at the Children’s Hospital of Philadelphia was funded by the Milbank Foundation. Two physicians, a cardiac intensivist, and a general pediatrician working on the complex care team participated in the program with the goal of building a PC skillset for their ongoing work within their core teams. Each attending physician spent a few weeks rotating with the consulting inpatient PC team and became trained facilitators for the VitalTalk communication skills program. Each built on their experiences to enhance primary palliative skills and awareness within their core teams and helped educate the PC team about the conditions their core teams treated.
Publisher Copyright:
© 2019 American Academy of Pediatrics. All rights reserved.
PY - 2019
Y1 - 2019
N2 - Integration of pediatric palliative care (PPC) into management of children with serious illness and their families is endorsed as the standard of care. Despite this, timely referral to and integration of PPC into the traditionally cure-oriented cardiac ICU (CICU) remains variable. Despite dramatic declines in mortality in pediatric cardiac disease, key challenges confront the CICU community. Given increasing comorbidities, technological dependence, lengthy recurrent hospitalizations, and interventions risking significant morbidity, many patients in the CICU would benefit from PPC involvement across the illness trajectory. Current PPC delivery models have inherent disadvantages, insufficiently address the unique aspects of the CICU setting, place significant burden on subspecialty PPC teams, and fail to use CICU clinician skill sets. We therefore propose a novel conceptual framework for PPC-CICU integration based on literature review and expert interdisciplinary, multi-institutional consensus-building. This model uses interdisciplinary CICU-based champions who receive additional PPC training through courses and subspecialty rotations. PPC champions strengthen CICU PPC provision by (1) leading PPC-specific educational training of CICU staff; (2) liaising between CICU and PPC, improving use of support staff and encouraging earlier subspecialty PPC involvement in complex patients' management; and (3) developing and implementing quality improvement initiatives and CICU-specific PPC protocols. Our PPC-CICU integration model is designed for adaptability within institutional, cultural, financial, and logistic constraints, with potential applications in other pediatric settings, including ICUs. Although the PPC champion framework offers several unique advantages, barriers to implementation are anticipated and additional research is needed to investigate the model's feasibility, acceptability, and efficacy.
AB - Integration of pediatric palliative care (PPC) into management of children with serious illness and their families is endorsed as the standard of care. Despite this, timely referral to and integration of PPC into the traditionally cure-oriented cardiac ICU (CICU) remains variable. Despite dramatic declines in mortality in pediatric cardiac disease, key challenges confront the CICU community. Given increasing comorbidities, technological dependence, lengthy recurrent hospitalizations, and interventions risking significant morbidity, many patients in the CICU would benefit from PPC involvement across the illness trajectory. Current PPC delivery models have inherent disadvantages, insufficiently address the unique aspects of the CICU setting, place significant burden on subspecialty PPC teams, and fail to use CICU clinician skill sets. We therefore propose a novel conceptual framework for PPC-CICU integration based on literature review and expert interdisciplinary, multi-institutional consensus-building. This model uses interdisciplinary CICU-based champions who receive additional PPC training through courses and subspecialty rotations. PPC champions strengthen CICU PPC provision by (1) leading PPC-specific educational training of CICU staff; (2) liaising between CICU and PPC, improving use of support staff and encouraging earlier subspecialty PPC involvement in complex patients' management; and (3) developing and implementing quality improvement initiatives and CICU-specific PPC protocols. Our PPC-CICU integration model is designed for adaptability within institutional, cultural, financial, and logistic constraints, with potential applications in other pediatric settings, including ICUs. Although the PPC champion framework offers several unique advantages, barriers to implementation are anticipated and additional research is needed to investigate the model's feasibility, acceptability, and efficacy.
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UR - http://www.scopus.com/inward/citedby.url?scp=85071055774&partnerID=8YFLogxK
U2 - 10.1542/peds.2019-0160
DO - 10.1542/peds.2019-0160
M3 - Article
C2 - 31366685
AN - SCOPUS:85071055774
SN - 0031-4005
VL - 144
JO - Pediatrics
JF - Pediatrics
IS - 2
M1 - e20190160
ER -