PICU and palliative care partnership to standardize family meetings and decrease ICU readmission rates

PICU and palliative care partnership to standardize family meetings and decrease ICU readmission rates

Frizzola M; Miller E; Hayman J; Levy C

Pediatrics

2018

child; conference abstract; controlled study; documentation; health care system; hospital readmission; human; intensive care; invasive procedure; length of stay; nurse practitioner; palliative therapy; protocol compliance; satisfaction; total quality management

Program Goals: The American College of Critical Care Medicine Task Force, 2004-2005 recommends "family meetings with the multi-professional team begin within 24-48 hours after ICU admission and are repeated as dictated by the condition of the patient with input from all pertinent members of the multi-professional team" (2007). We set forth to follow this recommendation through palliative care and pediatric ICU partnerships as well as standardized family meetings. We hypothesize that this will improve patient and family satisfaction, decrease ICU re-admission rates and may decrease overall length of stay and invasive procedures. We have developed a quality improvement project targeting patients that have had a re-admission to the PICU within 30 days. The project outlines the optimal timing of family meetings, provides a meeting content planner, and documentation template. The targeted patient population will receive an automatic palliative care consult to assist with the coordination and conducting of an initial family meeting. The frequency of subsequent scheduled family meetings will be determined based on patient/family needs and acuity of illness. In 2015, we found 42 re-admissions (3% of all PICU admissions) within a 30 day period. The majority of the readmissions were medically complex children with three or more co-morbid conditions. Our goal through implementation of this program is to decrease the readmissions by 20% within a one year time period. We intend to use a standardized format for these meetings as previously published by Nelson et al in 2009. Meetings will be attended by at least one family member, bedside nurse, ICU physician (fellow or attending) or Nurse Practitioner and palliative care team members. The family meeting documentation template will be created in our EMR to serve as both a guide for the meeting and documentation format. Evaluation We plan to monitor our protocol compliance by tracking readmissions, placement of palliative care consult order, family meeting occurring within 48-72 hours of readmission, documentation of the family meetings, and frequency at which family meetings are occurring thereafter. Upon successful implementation of our protocol, we will follow total length of stay, PICU length of stay and number of invasive procedures. Discussion Hospital re-admission rates are becoming a widespread concern throughout many healthcare systems. The majority of these pediatric re-admissions involve medically complex children. We hope this multi-disciplinary approach utilizing recommended best practices from the American College of Critical Care Medicine Task Force contributes to a decrease in ICU re-admission rates.

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