DOES THE PEDIATRIC EMERGENCY DEPARTMENT HAVE A ROLE IN PEDIATRIC PALLIATIVE CARE?

Abstract

BACKGROUND: Very little is known regarding the role of the pediatric emergency department (ED) in pediatric palliative care (PPC). OBJECTIVE(S): To explore pediatric emergency medicine healthcare professionals perspectives regarding their role in PPC and to compare these to other health care professionals understandings of the EDs role in PPC. DESIGN/METHODS: Interdisciplinary semi-structured focus groups were held with healthcare providers from pediatric emergency medicine, pediatric palliative care, pediatric complex care and pediatric intensive care. Exploratory open-ended questions introduced naturally occurring discussions and interactions. Data was transcribed in full and analysed using NVivo software. Data analysis was performed by thematic analysis and theoretical sampling. RESULT(S): From January to October 2016, 58 participants were interviewed; most were female nurses and physicians. ED providers seek to maintain continuity of care and uphold pre-established wishes throughout PPC patients ED visits by listening and supporting the patient and family, evaluating the clinical situation, communicating with primary care teams and organising rapid admissions to wards. Each interdisciplinary team demonstrated particular values and cultures, influencing their understandings of the EDs role in PPC; continuity of care is complicated by these distinct philosophies. Figure 1 describes the roles suggested by each group. Limitations to providing PPC in the ED are related to unsuitable physical environments, lack of uninterrupted time, efficiency expectations, unknown patients, provider lack of knowledge and moral distress. Solutions were directed at improving communication between teams and humanizing care to develop a sensibility to quality PPC in the ED. CONCLUSION(S): Although the perspective of ped iatric EDs role in caring for PPC patients is heterogeneous, several barriers to providing high quality emergency PPC can be overcome. Future studies will explore the experiences of PPC families presenting to the ED.(Fig 5).