A Quality Improvement Approach to Perinatal Palliative Care: Using Standardized Criteria and Education to Increase Early NICU Palliative Care Consultation.

BACKGROUND

Perinatal palliative care (PC) provides comprehensive, interdisciplinary, and planned care for infants with life-limiting or chronic critical conditions. Poor utilization of PC services was seen at our Level IV neonatal intensive care unit (NICU), limiting the care quality that was provided to these infants and their families.

PURPOSE: This quality improvement project aimed to increase the use of early PC consults for eligible infants from 33% to 100% from August to December 2022.

METHODS

The Promoting Action on Research Implementation in Health Services framework guided this quality improvement project. Standardized diagnostics, prenatal referrals, and chronicity trigger eligibility criteria were implemented in 1 NICU. The outcome measure was PC consult ordering compliance. De-identified patient data were collected by chart auditing, and consult compliance was analyzed with a control chart. The process measure was provider education, which was evaluated by descriptive and nonparametric analysis.

RESULTS

Median PC consult ordering compliance for eligible patients improved from 33% to 100% within 2 weeks of the first intervention and was maintained at 100% compliance for 10 weeks until project cycle completion. The median time from NICU admission to PC consult order entry was reduced from 40 to 15.5 days. Ninety-eight percent of the site healthcare providers received educational training. Clinician comfort in identifying PC-eligible infants significantly improved after the educational training (Z = 3.02, P = .003).

IMPLICATIONS FOR PRACTICE AND RESEARCH: Standardization of eligibility criteria and personnel education successfully improved early PC consult ordering within 1 NICU.