(879) Increase in Palliative Care Utilization in the PICU Between 2014-2023

Introduction: Palliative care (PC) was traditionally reserved for children at the end-of-life, but is now widely considered to be essential for optimizing the management of children and families with complex critical illnesses. This pilot study aimed to examine trends in PC usage over the past 10 years in a representative sample of Pediatric Intensive Care Units (PICUs). We hypothesized that PC use increased substantially over the past decade, but that significant differences remain in PC utilization across the United States (US).

Methods: In this repeated cross-sectional study, we leveraged the Pediatric Health Information System (PHIS), a billing database, to obtain de-identified data on all PICU admissions between 2014-2023. All patients ages 0-18 years at time of admission with a documented PICU stay were included. For the purpose of this analysis, PC usage was defined as documentation of “Encounter for Palliative Care” at any point in the PICU stay. Descriptive statistics were used to describe longitudinal trends in PC utilization by year. Pearson’s Chi-squared test was used to compare the proportion of patients who received PC between hospitals.

Results: Between 2014-2023, a total of 489,171 PICU admissions were captured in the PHIS dataset across 46 hospital systems. Overall, 3.6% of patients received PC consultations. Utilization of PC steadily increased over this time period, from 1.6% in 2014 to 4.5% in 2023. Palliative care usage increased by 2.8 fold over the 10 year study period. Significant differences in the proportions of patients receiving PC services by hospital system were found (p < 0.001), with a median of 2.8% (range 0.3-15.4%).

Conclusions: The delivery of palliative care in the PICU has increased significantly over the past decade, although degree of utilization varies by location. Future studies should focus on patient-level and site-specific factors that are associated with PC use, and attempt to identify disparities that may be addressed. By increasing access to PC in PICUs throughout the US, we may be able to improve the quality of life of our most vulnerable patients and their families.