Palliative Care Trigger Process in the Pediatric Intensive Care Unit: A Quality Improvement Project

Background Early integration of palliative care for pediatric intensive care unit patients and their families is beneficial for establishing goals of care and complex decision-making. Objective To implement the use of a trigger criteria process to deliver palliative care to a specific population of pediatric intensive care unit patients who would most benefit from receiving such care. Methods Trigger criteria were developed through a literature review and interprofessional work group discussions. Medical records were reviewed to compare the frequency of pediatric palliative care consultation 1 year before project implementation and during the 6-month project period. Intervention The pediatric palliative care trigger criteria process was integrated into 3 areas of the pediatric intensive care unit workflow. Staff members identified patients meeting the trigger criteria and initiated team discussion on the appropriateness of palliative care. A pediatric palliative care consultation was requested if the team agreed that it would be beneficial. Results Twelve of 18 patients (67%) had pediatric palliative care consultations during the 6-month project period using the trigger process, compared with 7 of 27 patients (26%) before process implementation. Conclusion Implementation of a trigger criteria process to identify patients with high needs for palliative care was successful and effective in the pediatric intensive care unit in the setting of limited palliative care availability. Reassessment of trigger criteria, integration of the trigger process into the electronic health record, and ongoing staff education will be required for long-term sustainability of the project.