P3B034: Introduction of the Symptom Management Plan for Pediatric Palliative Care Patients During Hospitalization

Purpose/Objectives: Pediatric Palliative Care patients make up a significant population served at large, tertiary pediatric hospitals. Patients included in our local pediatric Palliative Care Program made up 430 inpatient admissions (195 unique patients) from April 2022 to April 2023. These patients require individualized, multi-disciplinary, and subspecialty level care during hospitalizations. Strategies to empower caregivers to manage symptoms at home are critical as they can decrease hospital utilization and improve patient quality of life. The Symptom Management Plan (SMP) is a multi-system electronic health record (EHR) sick care plan created to provide caregivers with management guides for commonly experienced symptoms. The SMP has been shown to increase caregiver confidence and reduce emergency department visits and hospitalizations in the Palliative Homecare population in the outpatient setting. The goal for this quality improvement project is to expand utilization to a larger population of all patients who receive Palliative Care by creating or updating existing SMPs and reviewing plans with caregivers during hospitalization. Our aim is for 30% of the patients followed by Palliative Care admitted to the hospital medicine service to have an SMP created and reviewed at the time of discharge within 6 months of the SMP launch in the EHR inpatient environment.

Design/Methods: A multidisciplinary team was formed and QI methodology utilized. Ishikawa diagrams were used to assess provider barriers to implementation of the Symptom Management Plan in the inpatient setting. Providers (including resident and attending physicians) were educated on how to create and update SMPs. Individualized SMPs were created and reviewed with caregivers prior to hospital discharge. Data was collected via chart review to monitor Palliative Care patients who received a SMP prior to hospital discharge.

Results: The SMP was implemented in the inpatient EHR setting on September 29th, 2022. From October 2022 to February 2023, SMP utilization in the inpatient hospital medicine setting increased from 12% to 40% in the Palliative care population; however, utilization in March 2023 at 6 months post-implementation decreased to 9%. Data collection is ongoing.

Conclusion/Discussion: We have demonstrated implementation of the SMP for Palliative Care patients during acute hospitalization. This multi-disciplinary sick plan for caregivers is now being utilized in both the inpatient and outpatient settings to improve consistent home symptom management and transitions of care throughout all healthcare touchpoints for the patient. Despite a downtrend at 6 months post-implementation, there had been increasing utilization of the SMP. The next steps include examining etiologies for this downtrend, surveys of caregiver attitudes and satisfaction with receiving the SMP prior to discharge, as well as understanding provider feedback on barriers affecting utilization of this resource.