Improving the Quality of Pediatric Palliative Care: From Compassion to Sustainable Care

Abstract

Background: The development of a pediatric palliative care system using the Plan–Do–Study–Act (PDSA) approach, in collaboration with a multidisciplinary team, resulted in more systematic, comprehensive, and continuous care. The model incorporated individualized assessments of patients’ problems and needs, structured family meetings, and comprehensive advance care planning. Patients received effective symptom management, particularly for pain, which could be controlled within four hours. This led to a significant reduction in in-hospital mortality. Additionally, the average length of hospital stay and healthcare costs decreased, along with a lower rate of readmission. Family satisfaction was high, reflecting the effectiveness of the care system in significantly improving the quality of life of both patients and their families.

Objectives: 1. To develop a structured pediatric palliative care model and 2. To improve the quality of life of pediatric patients and their families.

Methods: This quality improvement initiative applied the Plan–Do–Study–Act (PDSA) framework. Patients and families were assessed by a multidisciplinary team to identify needs and develop individualized care plans. Family meetings facilitated communication, shared decision-making, and advance care planning. Coordination between hospital and home was emphasized to ensure continuity of care.

Results: The most common symptoms were dyspnea, pain, and drowsiness (71%, 57%, and 38%, respectively). All patients had access to opioid medications, and 88.9% achieved pain control within four hours. Family meetings and advance care planning were conducted for all patients. The in-hospital mortality rate decreased to 37%, and the average length of stay decreased to 23 days. The 28-day readmission rate was 4.76%. The average healthcare cost per admission decreased to 315,434.18 THB. Family satisfaction reached 98.8%.

Conclusion: The PPC care model improved symptom control and continuity of care, reduced in-hospital mortality, length of stay, and healthcare costs, and increased family satisfaction with care.