P3.I168: Answering State Legislature’s Call for Screening of Palliative Care in the Pediatric Emergency Department (PED)

Purpose/Objectives: Improving access to Pediatric Palliative Care (PPC) can improve quality of life in patients with life threatening and life limiting conditions. The New Jersey State and General Assembly passed S3117 in 2020, which mandated that every hospital should adopt a screening tool, to assess and increase access to palliative care in the PED. At Joseph M. Sanzari Children’s Hospital (JMSCH) at Hackensack University Medical Center, an interprofessional team consisting of palliative care clinicians, PED professionals, and an electronic health record specialist was formed to create the assessment tool and modeled after the adult palliative care tool. This screening process is a pilot project created in the electronic health record (EHR) and trialed in the PED at JMSCH.
An assessment tool was created within the background of the EHR which will screen all PED patients, this will lead to a BPA (best practice alert) to the provider to order a consult to PPC. Currently, only admitted pediatric patients ( < 22 years old) and neonatal intensive care unit (NICU) patients have a nursing palliative assessment tool which can result in a BPA following this current workflow.

Design/Methods: A BPA for patients at the PED, who meet the criteria of one Serious Illness and one Burden of Illness. The providers who will see the BPA are physicians, nurse practitioners, physician assistants and residents. The expected endpoint would be a new PED referral to PPC. There is no additional documentation for BPA to trigger, it is triggered from past and current documentation. Serious Illness is indicated in the problem list, medical history and clinical impression and diagnosis. Burdens of Illness are specific central lines, drains and airways(tracheostomy, NIPPV), pain score >4 on any scale used in the pediatric hospital, past orders of hospice and palliative care, three or more visits in the last 30 days and chief complaint. New referral for discharged patients are sent to a common in-basket for palliative care providers, admitted patients can have an inpatient consult done.

Results: Proposed metrics are total number of pediatric patients screened, number of in basket referrals, number of office consults.

Conclusion/Discussion: The pilot project, although created as a response to public policy, is important because it will improve access to PPC for patients presenting to the PED, not only those admitted to the JMSCH. The ongoing refinement and implementation of this pilot project will allow for improved access to palliative care for our youngest and most vulnerable patients.