P3.118: Pediatric Hospice - More than the Sum of the Parts

Purpose/Objectives: Pediatric hospice capacity is limited in outlying regions. Developing pediatric hospice capacity there requires new approaches involving partnerships with existing organizations. Our goal was to create pediatric hospice/palliative medicine (pHPM) capacity where services were absent. Our intention was to create a strongly bonded partnership between several independent organizations in the community. A yearlong training program was created to impart core pHPM skills to the inpatient children's hospital and the community adult providers.

Design/Methods: A consortium formed in 2023 between stakeholders committed to pHPM, including a small, tertiary children’s hospital, a community hospice providing counseling/bereavement but no clinical care, a VNA licensed to provide hospice services, and CenCal Health, serving Santa Barbara and San Luis Obispo Counties. A pHPM physician with program development experience participated as an advisor. Organizational meetings took place over nine months via Zoom with participants from each organization. Strengths and resources of each organization were identified. Gaps were identified in clinical staffing and HPM expertise. Formal commitments to the partnership were made and philanthropic funding for training was obtained. Over the next year, an education program was offered led by two nationally recognized pHPM nurse educators in concert with consortium leaders. The education program was based on a model developed at Children’s National Hospital involving several in-person didactic sessions over the year (lectures, small groups, and role play) and monthly virtual check-in sessions. Each of the 50+ participants created a quality improvement project in small groups, which was developed over the yearlong course and presented at the final in-person session. Two additional regional hospices were brought onboard in recognition of the disparate geographic distribution of patients.

Results: Gaps: Limited understanding in hospital of pHPM and referral process and lack of comfort amongst adult providers caring for children. Education was developed at the children’s hospital through Grand Rounds and one-on-one staff education. Recurring reviews of referrals allowed feedback and calibration of the inpatient consultation process. More than 50 nurses, social workers, counselors, physicians, and chaplains completed the training and provided enthusiastic feedback: "informative, inspiring" "appreciated the communication approach" on the experience. Individual project summaries will be presented. A non-competitive partnership with two other hospices developed as catchment areas do not overlap.

Conclusion/Discussion: This project demonstrates success in creating de novo pHPM capacity. Experienced trainers can effectively impart critical core pHPM information virtually and in-person. This approach is applicable in a wide range of community settings, leveraging technology and expert guidance, when willing partnerships are developed. It can serve as a model for other regions in which adult hospice services exist, but staff are hesitant to care for pediatric patients. Commitment of hospital/hospice leaderships to the program and staff buy-in are essential components for success. Collaboration with regional MCOs is essential.