P3B036: A Single-center Retrospective Study on Palliative Care Consults and Associated Outcomes in the Pediatric Intensive Care Unit

Background: Pediatric palliative care (PPC) services in the pediatric intensive care unit (PICU) provide broader support for critically ill patients and their families. The hypothesis is that PPC consultation is associated with an increase in end-of-life discussions and advanced decision-making, strengthening family support during a child's dying process.

Methods: This is a retrospective chart review of patients who died at Northwell’s Cohen Children’s Center PICU and the presence and absence of PPC consults. IRB approval was obtained. The presence of goals of care (GOC), end-of-life (EOL) discussions, DNR/DNI order, MOLST completion, interdisciplinary support, withdrawal of life-sustaining therapies, hospice discussion, legacy/memory-building services were studied. Descriptive data included age at time of death, length of stay (LOS) in the PICU, gender, race, spiritual preference and diagnosis.

Results: Data were collected from 167 charts from 2018-2022. Average age: 6.7 years (range: 2 days-27 years), average PICU LOS: 16.9 days (range: 2 days-358 days), 50% female, 31% mixed race, 26% Black, 25% White, 10% Asian, 7% unknown, and 25% Hispanic. Most (79%) spoke English as their main language, 15% Spanish, 6% other. Most (71%) had complex chronic conditions.

In 92% of cases, a GOC discussion took place, 58% involved PPC. Teams leading GOC discussions were PICU (94%), PPC (57%), Cardiology (14%), Neurology (10%), Oncology (21%), and Neonatology (7%).

In 87% of cases, EOL planning took place, 58% involved PPC. Teams leading EOL planning were PICU (83%), PPC (60%), Cardiology (7%), Neurology (2%), Oncology (18%), and Neonatology (3%). Often, GOC and EOL discussions were co-led by multiple teams.

Overall, 79% had a DNR order, 40% with a MOLST, 67% offered chaplaincy, 100% involved social work, 84% offered child life services, 17% had hospice consideration, 56% with legacy building, 53% had withdrawal of life-sustaining care, and 17% had pre-established relationships with the PPC team.

For cases with PPC involvement (n=99), in GOC and EOL discussions (vs no PCC), metrics were: DNR (85% vs 69% respectively, p=0.03), MOLST (48% vs 27%, p=0.02), chaplaincy (71% vs. 60%, p=0.16), social work (100% vs. 100%, p=N/A), offered child life (91% vs 74%, p< 0.01), hospice discussion (24% vs. 7%, p< 0.01), legacy building (61% vs. 50%, p=0.18) and withdrawal of life-sustaining care (60% vs. 41%, p=0.03).

Conclusion: PPC in the PICU is associated with improved quality indicators - supporting families suffering through a highly difficult and harrowing experience of loss, through a multidisciplinary team effort. Next steps include expanding this study to other sites within the health system and looking at specific programs to measure system-wide effectiveness.