Inpatient Pediatric Palliative Care Consult Requests and Recommendations.
Kristin Carter, Jennifer Raybin, Lilliam Ambroggio and 4 others
PMID 34810051WHAT IT FOUND
Pediatric palliative care consults were requested most often for life-threatening illness or goals of care.
Pain, nutrition, and agitation were common symptoms. Social work or spiritual care was recommended in nearly all consults. Discharge planning was not frequent.
Key findings
01Consult requests were most commonly for a life-threatening illness or goals of care, regardless of patient location or type, and social work and hospital-based spiritual care were recommended in nearly all consults.
02Ward consults occurred earlier than ICU consults, at a median of 4 days versus 8.5 days, and discussion of preferred location of death was more likely on wards.
03Established patient consults occurred at a median of 4 days versus 11 days for new patients, and established patients more often received community palliative or hospice service recommendations.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single-center retrospective design, so referral patterns and consult practices may not apply to other hospitals. Reasons for consult were taken from primary team orders, which may not fully reflect why the team wanted palliative care input. 18.7% of encounters had no consult order, and 3.7% had an order without a reason, which may skew consult request findings. Recommendations that were not written in the initial consult note were not captured. Only the initial consult note per admission was analyzed, and patients with repeated admissions contributed more than one encounter, so encounter counts and patient counts differ. The study describes requests and recommendations, not whether patients, families, or providers benefited.
Declared interests
The supplied text does not include an author conflict of interest statement. The publication types list research support from NIH extramural.
The easy way to misread this
Do not read the differences in consult requests and recommendations as evidence that one palliative care consult pattern improves child or family outcomes. The study described charted requests and recommendations and did not measure patient outcomes.