Factors associated with place of death for children in South Yorkshire: a retrospective cohort study.

OBJECTIVES: Place of death (POD) is considered a key quality indicator for adult end of-life care, but paediatric evidence is limited. Data from Child Death Overview Panel (CDOP) databases provides an opportunity to describe trends in POD as regional paediatric palliative medicine (PPM) options have increased. Aims were to identify and describe trends in POD for children in South Yorkshire. METHODS: Retrospective cohort study. Anonymised data extracted from five CDOP databases 2008-2015. Data included age, gender, ethnicity, postcode (outward code only), POD, classification and category of death. Descriptive statistical analysis using χ2 test was used to assess intergroup differences. RESULTS: 748 deaths were notified from 2008 to 2015. Neonatal deaths were excluded, 46% (n=345). Of non-neonatal deaths (n=403), 58% (n=232) were 'expected'. Of expected deaths (n=232), 19% (n=45) died in home, 19% (n=45) died in hospice and 61% (n=141) died in hospital. This was significantly different from comparable national data which showed considerably more hospital deaths. There was no significant change in POD over time. CONCLUSION: Hospital remains the POD for most children, whether deaths are 'expected' or not, suggesting specialised PPM should be expanded into the hospital setting. More research is needed regarding preference for POD. This study may help inform future service planning for PPM and hospice development.

Educational impact of paediatric palliative simulation study days.

BACKGROUND: The use of simulation-based medical/nursing teaching is increasingly widespread. Simulation-based teaching offers an immersive learning experience where professionals can practice communication and practical skills in a safe, authentic environment. We designed a paediatric palliative simulation study day primarily aimed at nursing staff who manage these patients in the community/hospice. We believe this is the first of its kind in the UK. AIMS: To establish whether attendance at a paediatric palliative simulation study day improved confidence and knowledge in management of common and/or difficult situations in palliative care. METHOD: Health professionals working at local paediatric hospices or in associated specialties to palliative care were invited to attend the free 1-day course. 5 scenarios were developed by experienced health professionals working in paediatric palliative care. On the day, participants were asked to complete a questionnaire to check basic demographic data, confidence levels and knowledge (50 true/false questions). Following participation/observation of 5 scenarios, they again completed the same questionnaire regarding confidence levels and knowledge. Results were analysed with Excel and XLStat using basic demographic data and Wilcoxon signed rank two-tailed test. RESULTS: 57 healthcare workers participated in 5 study days. 81% (n=47) professionals described themselves as working primarily in palliative care. Only 35% (n=20) had previously experienced simulation. Based on confidence questions, attendees felt more confident in managing specific palliative scenarios (p<0.0001). Based on true/false questions prestudy and poststudy day, 86% (n=49) of participants improved their knowledge. The median improvement score for the cohort was 3 (p<0.0001). CONCLUSIONS: The study demonstrated a significant improvement in confidence and knowledge following the simulation course. This supports further time/financial investment in developing this type of study day. Simulation is a useful teaching adjunct in paediatric palliative care. The course also provides a valuable opportunity for professionals to network and discuss/share experiences.