The Chameleon Project: A children's end of life care quality improvement project
Chameleon Project; children; end-of-life; quality improvement project
Objective: NHS England's Marginal Rate Emergency Threshold (MRET) and Readmission Fund funded the Chameleon Project 2018 (Twitter account: @chameleonproje1), to improve children's end of life care. This funded a lead disability paediatrician with expertise in Paediatric Palliative Care (10h/wk), a children's palliative care nurse (3d/wk) a network administrator (2d/wk), and additional hours for paediatricians in the critical care, oncology, and neonatal units, and in each of the local district general hospitals (total 18h/wk). Method(s): Tools were developed to aid identification of children in the last year of life and to support anticipatory care planning. The team attended ward rounds and provided teaching sessions, advice and support. Children who died an expected death in the 12 months of the project were ascertained from the child death review teams. Non-elective admissions, bed days, and costs were tabulated. We also evaluated the documentation of care plans and post bereavement family feedback questionnaires. Result(s): 29 children died an expected death. The same number died during the previous 12 months. The median number of non-elective admissions reduced from 2 to 1 per child, specialist ward bed days reduced from 504 to 251 (50% reduction). For children admitted to PICU in the last 12 months of life, the total PICU bed days reduced from 342 to 184 (46% reduction), the median length of stay reduced from 21 days to 11 days, and the maximum length of stay reduced from 141 days to 38 days. The percentage of children who died an expected death who had documented anticipatory care plans rose from 50% to 72%. Conclusion(s): The network of clinicians with expertise in paediatric palliative care working together across a region improved anticipatory care planning and reduced admissions and bed days for children in their last year of life: better care with reduced costs.
Wolff A; Dorsett C; Haynes S; Whitehouse W P; Clements H; Griffin H; Chhaochharia A; Connolly A; Kelly N; Turnbull J; Deorukker S; Hill S; Batey N; Douglas E; Sheikh N; Bifani E; Lovegrove S; Webb K; Manning J
Developmental Medicine and Child Neurology
2020
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/dmcn.14411" target="_blank" rel="noreferrer noopener">10.1111/dmcn.14411</a>
The chameleon project: A children's end of life care quality improvement project: Preliminary results
child; child death; human; palliative therapy; controlled study; pediatric intensive care unit; terminal care; bereavement; conference abstract; hospital admission; newborn; questionnaire; documentation; cost control; England; preliminary data; teaching; total quality management
Background As there was no specialist paediatric palliative care team in the region, we made a successful bid to NHS England's Marginal rate Emergency Threshold (MRET) and Readmission Fund for the Chameleon Project1 in 2018. The project has been funded for 12 months to audit and improve children's end of life care across the region. It provides a regional specialist team: consultant paediatrician 2 days a week, clinical nurse specialist 3 days, clinical academic researcher 2 days, network administrator 2 days, 3 paediatricians with expertise in palliative care in each of 3 district general hospitals 0.5 days. Methods The team developed tools to aid identification of children with end of life care needs. These were embedded by weekly attendances by the team at ward rounds and board rounds in the region's hospitals. We also delivered lectures and case based teaching sessions to clinical teams and at regional study days. A bereaved family feedback tool was adapted from ones used by the London Neonatal Network. Children with life limiting conditions who died an expected death in the 12 months of the project were identified from the child death review databases. Numbers of specialist hospital admissions, bed days, and costs were identified. Quality of care will be evaluated from documentation of care plans and post bereavement family feedback questionnaires. Results Compared to the year before the project started, the mean number of non-elective admissions reduced from 2.3 to 1.9; the number of non-elective bed days reduced from 51 to 32; and the number of non-elective bed days on neonatal and paediatric intensive care units reduced from 28 to 20, in the last 12 months of life per child. Quality of care is currently being assessed against NICE Quality Standards QS160.2 Conclusions These preliminary results indicate that a dedicated paediatric palliative care team can reduce admissions and bed days for children in their last year of life. We hope that further analyses will demonstrate improved family experience and cost savings for local NHS providers.
Haynes S; Kelly N; Turnbull J; Griffin H; Connolly A; Dorsett C; Brown J; Wolff A
Archives of Disease in Childhood
2019
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1136/archdischild-2019-rcpch.456" target="_blank" rel="noreferrer noopener">10.1136/archdischild-2019-rcpch.456</a>