Planning
The quality improvement study was designed and analyzed according to A3 methodology. The study team included 2 hematology oncology fellows (SF, OO), an oncology APRN (LT), a pediatric hospitalist with expertise in quality improvement and patient safety (NC), the medical director of the palliative care team (JSL), palliative care team faculty (JS, KE) and a pediatric hematology oncology attending (KL).
As mentioned previously, the initial project scope was identified as pediatric patients with cancer diagnoses predicted to have a 5-year EFS of less than 50%based on nationally reported survival curves. The 5-year EFS is a marker of mortality in oncology and informed the creation of a ‘target list’ of diagnoses for which PPC consult was recommended. The project team met with the oncology clinicians designated as leaders for disease subsets and obtained input on the target list. We also met with the PPC team prior to project initiation to review processes and ensure staffing availability for the anticipated increased consults.