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Objective: Perinatal palliative care (PPC) is the coordinated application of palliative care principles to the care of families, fetuses and newborns with suspected life limiting conditions. This approach relies on continuity of care that spans pregnancy, birth and beyond. The goal of this retrospective cohort study was to evaluate outcomes and PPC continuity in infants born to families who received PPC at a quaternary care pediatric hospital, and to identify targets to improve care continuity. Study Design: PPC patients seen between July 2018 and June 2021 were identified via local PPC registry. Demographic, outcome, and continuity data were gathered from the electronic medical record. Descriptive statistics were used to calculate the rate of postnatal palliative consult and infant mortality rates. Results: 181 mother-infant dyads were identified as having a PPC consultation and had available data following birth. Overall perinatal mortality was 65%; 51% of all liveborn infants died prior to discharge. Only 48.1 % of liveborn infants who lived for more than 24 hours received postnatal palliative care. Location of birth (primary versus non-network hospital) was significantly associated with postnatal PPC consult rate (p=0.007). Conclusion: Continuation of palliative care after birth in families who received perinatal palliative care is inconsistently achieved. Creating reliable systems for PPC continuity will depend on location of care.

Sport-related concussions (SRCs) occur at alarming rates among adolescents and evidence suggests that adolescents experience more severe and longer-lasting symptoms compared to other age groups. Developmentally, adolescence is a time when youth become less reliant on their parents, establish their personal identity, and rely more on other social support networks (e.g., peers, teammates). However, previous studies show that parents play a prominent role in the recovery process from an SRC, especially in situations where recovery is prolonged. The purpose of this study was to examine the lived experiences of parents/guardians of teens who were recovering from a concussion and whose symptoms were persistent. Participants ( N = 12) were individually interviewed to better understand how they navigated and advocated for their teen during their prolonged recovery. An inductive content analysis revealed eight thematic categories that were interpreted with a developmental lens: (a) difficulties enforcing cognitive and physical rest, (b) concerns about depression and isolation, (c) observing struggles with athletic identity, (d) feelings of frustration, helplessness, and stress, (e) challenges of a hidden injury, (f) decisions about returning to sport, (g) being lied to about symptoms, and (h) offering strategies and practical advice. The themes illustrate how challenging and complicated the recovery process can be for parents of teenagers in particular, which is supported in previous concussion studies and the broader developmental literature. These results reinforce the idea that taking a biopsychosocial approach to care is best in order to adequately support parents/guardians and adolescents during the SRC recovery process.

Objective:To explore parents’ knowledge, attitudes and behaviours regarding sugar-sweetened beverages (SSBs, e.g. soft drinks, juice drinks, sports drinks) and other beverages provided by parents at youth sports events.Design:Qualitative analysis of focus group discussions.Setting:Ada County, Idaho, USA.Method:A total of 3 focus groups were conducted with 24 parents of 6- to 11-year-old children participating in one community recreational soccer league. Parents were asked how they selected beverages for their children at soccer practices and games, and shared ideas for improving healthy beverage consumption in this setting. Two coders performed an inductive content analysis of the focus group transcripts, and an external reviewer established the trustworthiness of the data.Results:Parents expressed uncertainty about which beverages other than water were best for children’s health and performance. Beverage choices were affected by factors such as cost, convenience, the weather, the level of competition and children’s ages. Parents also noted the influence of coaches, other parents, their children’s preferences, their beverage habits at home and the media. Parents desired evidence-based guidance on optimal beverages for youth athletes and recommended specific interventions to reduce consumption of SSBs in the context of youth sport events.Conclusion:Results indicate the need for developmentally appropriate expert recommendations for healthy beverage consumption in recreational youth sport, and reinforce findings from existing research which suggest that parents desire support to ensure healthy beverages are offered at youth sports events.

Concussion, or mild traumatic brain injury, especially among young children, teenagers, and young adults, is a significant problem in Ada County, Idaho, and the United States. Although much has been learned about concussion, considerable controversy and gaps in knowledge still exist in many areas of research, leading to variation in concussion assessment, treatment, and management protocols. Health systems can positively impact concussion outcomes through community education and outreach, and provision of timely, coordinated, evidence-based clinical care. Collectively, these measures serve to reduce concussion incidence (primary prevention), enable more timely recognition of concussion by parents, coaches, and teachers of youth athletes (secondary prevention), and improve treatment of concussion after it has occurred (tertiary prevention). Using the concussion prevention and clinical care coordination activities of St. Luke's Health System in Idaho as a benchmark, this analysis estimates the economic value of these preventive measures, in particular those preventive measures that target the pediatric population, for Ada County and the state of Idaho, and includes both year of injury and long-term costs of concussion. This study adopts a societal perspective, incorporating savings in direct medical, indirect, and quality of life costs.

PURPOSE: The goal of this study was to evaluate the performance of a pediatric stratification tool that incorporates health and non-medical determinants to identify children and youth with special health care needs (CYSHCN) patients according to increasing levels of complexity and compare this method to existing tools for pediatric populations. METHODS: This retrospective cohort study examined pediatric patients aged 0 to 21 years who received care at our institution between 2012 and 2015. We used the St. Luke’s Children’s Acuity Tool (SLCAT) to evaluate mean differences in dollars billed, number of encounters, and number of problems on the problem list and compared the SLCAT to the Pediatric Chronic Conditions Classification System version2 (CCCv2). RESULTS: Results indicate that the SLCAT assigned pediatric patients into levels reflective of resource utilization and found that children with highly complex chronic conditions had significantly higher utilization than those with mild and/or moderate complex conditions. The SLCAT found 515 patients not identified by the CCCv2. Nearly half of those patients had a mental/behavioral health diagnosis. CONCLUSIONS: The findings of this study provide evidence that a tiered classification model that incorporates all aspects of a child’s care may result in more accurate identification of CYSHCN. This would allow for primary care provider and care coordination teams to match patients and families with the appropriate amount and type of care coordination services.

A 14-year-old girl with a history of complex congenital heart disease in end-stage heart failure and with cyclic vomiting was admitted to our hospice program in 2012. Before hospice enrollment, she had required intermittent infusions of dexmedetomidine to abort cyclic vomiting episodes after cardiac catheterization procedures. Following a hospital admission in November 2013, she was discharged home in the care of our hospice on a continuous dexmedetomidine infusion. She remained on this infusion at varying doses (range of 0.1-0.38 mcg/kg/hour) for nearly three years, until her death in September 2016. This report describes the palliative use of dexmedetomidine in this patient and difficulties related to the use of this medication during the course of her care.

Aim: The ability to communicate serious news to patients and families in a caring and compassionate way is a critical skill for physicians. This study explores the impact of a novel communication skills workshop that included bereaved parents in role play on pediatric residents’ confidence to communicate serious news. Methods: Following the workshop, pediatric residents were surveyed to assess their perceived efficacy of the educational intervention. The survey included anchored response and open-ended questions to yield qualitative and quantitative results. Results: After completing the workshop, residents’ confidence in discussing goals, managing emotions, and expressing empathy all increased significantly. Residents reported that the inclusion of bereaved parents was beneficial since it made the experience more realistic. In addition, they believed their ability to communicate with patients and families had improved. Conclusions: Including bereaved parents in this communication skills workshop improved the residents’ confidence in discussing serious topics and enhanced the reality of the experience.

The ability to communicate serious news to patients and families in a caring and compassionate way is a critical skill for physicians. This study explores the impact of a novel communication skills workshop that included bereaved parents in role play on pediatric residents' confidence to communicate serious news.Following the workshop, pediatric residents were surveyed to assess their perceived efficacy of the educational intervention. The survey included anchored response and open-ended questions to yield qualitative and quantitative results.After completing the workshop, residents' confidence in discussing goals, managing emotions, and expressing empathy all increased significantly. Residents reported that the inclusion of bereaved parents was beneficial since it made the experience more realistic. In addition, they believed their ability to communicate with patients and families had improved.Including bereaved parents in this communication skills workshop improved the residents' confidence in discussing serious topics and enhanced the reality of the experience.

Rapid Cycling Quality Improvement in Community Palliative Care (TH304) Arif Kamal, MD, Duke University, Durham, NC. Ashlei Lowery, MD, Duke University Health System, Durham, NC. Charles Stinson, MD, Forsyth Medical Center, Winston Salem, NC. Debra Blue, MD, Hospice of Wake County/Horizons Palliative Care, Raleigh, NC. Janet Bull, MD, Four Seasons Hospice, Flat Rock, NC. (All authors listed above had no relevant financial relationships to disclose with the following exception: Bull received honoraria from and served on speakers bureaus for Meda and Pfizer as well as served on the scientific advisory board and speakers bureau for Salix.)