Objectives Perinatal Palliative Care¹ supports the needs of parents, who following antenatal diagnosis of a life limiting fetal condition (likely to result in fetal/neonatal death)² choose to continue their pregnancy. Uptake of new Antenatal Palliative Care Pathway³ was poor. Over a 4-month baseline, the regional fetal-maternal diagnostic centre made one of total seven antenatal palliative care referrals (14%). This quality improvement (QI) project aimed to increase referrals from the regional Centre for Fetal Medicine (FMC) and hence promote early access to support following diagnosis. Methods A 9-month QI project was undertaken using the Model for Improvement⁴ and Plan-Do-Study-Act⁵ tests of change. The QI team was a collaboration between fetal medicine, obstetrics, neonatology, midwifery, children's hospice and paediatric palliative care. Stakeholder engagement and pre-intervention staff survey suggested three work streams: 1. Sharing the referral process. 2. Increasing palliative care presence. 3. Antenatal palliative care awareness training. Outcome measures included antenatal palliative care referrals initiated by the FMC, and time interval from diagnosis to referral. Process measures included staff complian ce with referral process and training. Balancing measures considered resource implications and change in staff understanding and comfort. Results Analysis was performed using descriptive statistics and annotated run charts. A consensus trigger-list of life limiting fetal conditions comprised anencephaly, bilateral renal agenesis, severe skeletal dysplasia, trisomy 13/18 and triploidy. FMC referrals for those continuing pregnancy with trigger-list conditions increased from 17% to 100%. At baseline (n=5), the mean gestation at referral was 29⁺⁴ weeks, with range of 14–121 days from diagnosis to referral. For the QI group (n=4), the mean gestation at referral was 22⁺⁰ weeks, with range of 1–22 days. Pregnancy termination was a confounding factor, with the proportion continuing pregnancy with trigger list conditions falling from 50% at baseline to 14%. The total number of antenatal palliative care referrals did not fall, with an increase in referrals with uncertain prognosis. Over the QI project, 86% (12/14) of total antenatal palliative care referrals were made by the FMC. Staff reported increased comfort with sharing antenatal palliative care option and the proportion who knew how to make a referral increased from 46% to 90%. Conclusion The quality improvement project achieved aim with the FMC now the lead referral source. Palliative care staff embedded within the FMC help sustain the improvement. Future qualitative studies could explore user experience and optimal timing for antenatal palliative care involvement. References British Association for Perinatal Medicine. Palliative Care – A Framework for Clinical Practice in Perinatal Medicine. 2010 Wilkinson DJC, de Crespigny L, Xafis V. Ethical Language and decision-making for prenatally diagnosed lethal malformations. Seminars in Fetal and Neonatal Medicine, 2014;19(5):306–311. Regional Paediatric Palliative Care Network. 2022. Northern Ireland Palliative Care Pathway and User Guide. Langley GL, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). 2009. Deming WE. Out of the Crisis. Cambridge, MA: Massachusetts Institute of Technology Center for Advanced Engineering Study. 1983.
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McGinn et al. (2024) studied this question.