Minding the Gap: Sustaining Pediatric Palliative Care Teams in High Demand (FR244)

Abstract

Outcomes 1. Discuss common factors that lead to mismatch between the clinical demand and available workforce in pediatric palliative care (PPC) 2. Examine the relative merits of heroics versus sustainability and boundaries in medical culture 3. Summarize sustainability principles to distinguish between opportunities and triage work when teams are not able to serve all patients who are candidates for PPC Pediatric palliative care (PPC) teams across the nation have experienced challenges when the demand for clinical services is greater than the available workforce. These circumstances present a particular challenge for the work of PPC as compared to other medical specialties given the time- and energy-intensive nature of the work, the generally small size of PPC teams, and the relative scarcity of PPC in each geographic area. Opportunities can be realized for increased clarity about mission and increased efficiency of staff, but there are many situations that cannot be resolved simply through process optimization. Little has been written about this topic, but it is crucial for the PPC community to share experiences and perspectives as we continue to build our field. Following a concise review of the literature on medical models of care, we explore the circumstances that can lead to demand-workforce mismatch with accompanying strategies for minimizing periods of team vulnerability. Boundaries of healthy teams will be emphasized, underscoring the inclination in medical culture to promote heroics over sustainable models to promote longevity and workforce health. We will discuss the experience of 3 PPC teams who have recently faced similar circumstances and reflect on the productive and challenging aspects of each. Principles for triaging consults and follow-up visits, considering flexibility in staffing models, and balancing systems demands will be synthesized from the shared experience. Attendees will be invited to reflect on the circumstances of their own teams and consider what proactive steps might be taken to help minimize risk for demand-workforce mismatch and strategize about how to leverage high patient volume for increased PPC resources.