Empowering Pediatric Palliative Homecare Patients and Caregivers with Symptom Management Plans
Electronic health record; Home care; Pediatric palliative care; Quality improvement; Symptom management
Pediatric palliative home-based care has been shown to improve symptoms, quality of life, and coordination of care. Despite these successes, hospital utilization in our own palliative home-based care population remained high as some caregivers lacked confidence to manage symptoms at home and had difficulty in recalling or accessing "sick care plans." Our team developed the Symptom Management Plan (SMP), a multi-system "sick care plan," as a quality improvement project with the aim of improving caregiver confidence to manage symptoms at home. An Electronic Health Record-based SMP template was created for common symptoms: respiratory distress, seizures, feeding intolerance, and constipation with core subspecialists' input. Individualized SMPs were created and reviewed with caregivers at every subsequent palliative home nursing visit. Caregivers were surveyed on their confidence 3 and 6-months post-implementation. Resource utilization was analyzed throughout implementation. At 6 months, 73% of caregivers reported "better" or "much better" confidence in managing their child's symptoms after using the SMP, and 76% of caregivers perceived the SMP prevented urgent care or emergency department (ED) visits. After the SMP was launched, the rate of ED visits decreased from 0.86 to 0.47 per 100 patient-days, and admissions decreased from 0.56 to 0.39 per 100 patient-days. These rates further decreased to 0.31 ED visits and 0.19 admissions per 100 patient-days within 4 and 6 months. Introducing the SMP for our home-based palliative care patients was associated with improved caregiver confidence in managing acute symptoms at home and a reduction in hospital utilization.
Larrow A; Doshi A; Fisher E; Patel A; Marc-Aurele K; Rhee KE; Beauchamp-Walters J
Journal of Pain and Symptom Management
2022
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<a href="http://doi.org/10.1016/j.jpainsymman.2022.06.015">10.1016/j.jpainsymman.2022.06.015</a>
Impact of Home-Based Pediatric Palliative Care on Hospital and Emergency Department Utilization at a Single Institution
ED utilization; Emergency department; Home-based care; Hospital; Hospital utilization; Pediatric palliative care
Background: There is limited data on home-based pediatric palliative care (PPC) demographics and utilization outcomes. Objective(s): Describe who receives home-based PPC and compare emergency department visits, hospital admissions, and hospital days admitted in the one year before and after initiation of home-based PPC. Design(s): Exploratory retrospective medical chart review. Settings/Subjects: Patients, from birth to their 21st birthday, who received home-based PPC during January 1, 2015 to July 31, 2016 at a single site. Measurements: Demographics and hospital utilization were extracted from the medical chart. Result(s): N = 154. Comparing one year before and after initiation of home-based PPC, the median number of hospitalizations decreased from 2 to 1 (p < 0.001), and the median total number of hospital days admitted decreased from 16 to 4 days (p < 0.001). Conclusion(s): Children enrolled in a home-based PPC program experienced a significant decrease in the number of hospital admissions and hospital days admitted. © Copyright 2022, Mary Ann Liebert, Inc., publishers 2022.
Bower KA; Lau M; Short R; Lawrence S; Beauchamp-Walters J; Marc-Aurele K
Journal of Palliative Medicine
2022
<a href="http://doi.org/10.1089/jpm.2021.0307" target="_blank" rel="noreferrer noopener">10.1089/jpm.2021.0307</a>