ABSTRACT
BACKGROUND AND AIM: Cardiac Intensive Care Unit (CICU) interdisciplinary staff play an integral role supporting children and families at end-of-life (EOL). We examined staff's perceptions of quality of dying and death (QODD) before and during the COVID-19 pandemic. METHOD(S): We performed a cross-sectional survey of staff involved in all CICU deaths 6.30.2019-7.1.2021. Staff completed demographic questions, the pediatric-QODD instrument (standardized to 100), rated quality of the moment of death and the 7 days prior (0-terrible, 10-ideal). Intense EOL care included mechanical support, open chest, or cardio-pulmonary resuscitation. RESULT(S): 713 surveys were completed (72% response rate) for 60 deaths, including 455 (64%) during the pandemic, 246 (35%) from nurses, 208 (29%) medical providers, and 259 (36%) allied-health staff. Clinical experience varied (42% <=5years). 33 patients (55%) were receiving intense care. Median scores were 93 for QODD [IQR 84, 97], 9 for moment of death (IQR 7, 10), and 5 (IQR 2, 7) for the 7 days prior. QODD scores were 3 points lower for nursing and allied health compared to medical providers (p<0.001) and for staff with <5years of clinical experience compared to >15years (p=0.002)(figure). Intense care was associated with lower scores for moment of death and 7 days prior (both, p=0.001). Responses pre-COVID-19 and during the pandemic were similar (figure). CONCLUSION(S): Overall CICU staff positively perceived QODD with lower scores for quality of the 7 days prior to death. Perceptions varied by staff characteristics and medical intensity with no influence from the pandemic. Our data guide strategies to meaningfully improve staff wellbeing and EOL experiences. (Figure Presented).