CLIs were a helpful adjuvant in the four cases presented and may be an effective therapy for a more diverse array of refractory cancer pain. The majority of patients experienced pain relief well beyond the metabolic elimination of the lidocaine, corroborating a modulation effect on pain windup. Additional research regarding infusion rates, serum concentrations, side effects, and outpatient follow-up in a larger group of patients will provide additional insight into the role and safety of this therapy in children.

Introduction: Quality improvement and patient safety are important elements of quality patient care. National medical boards and graduate medical education accreditation guidelines support integrating formal quality improvement and patient safety efforts into training and practice. In order to design and implement effective quality improvement projects, fundamental knowledge and tools are imperative. We sought to develop a formal quality improvement curriculum for house staff early in their training to give them insight and tools for longitudinal engagement. Methods: This curriculum contains guides for four facilitated sessions: introduction, value stream mapping, root cause analysis, and patient safety. Each session has a knowledge component to be delivered outside of class and a practice component whereby participants use their knowledge to participate in a group activity using a quality improvement tool. Results: This curriculum has been provided to more than 80 house officers over 3 years. Knowledge assessment showed improvement on all assessed categories of the training. Engagement in longitudinal quality improvement projects by trained residents has also improved. Discussion: This curriculum provides succinct fundamental tools to learners seeking to undertake longitudinal quality improvement projects. While initially designed for physician trainees, the tools and training are not specific to that group and can be used broadly for interested facilitators.

BACKGROUND AND OBJECTIVE Parents of children with complex chronic conditions report fragmented care, unmet medical needs, and financial strain from health care costs. The aim of this study was to identify both prevalent themes discussed during pediatric palliative care consultation of patients with complex chronic conditions cared for by pediatric generalists and variation in consultation content by age and timing of consultation in disease course. METHODS Forty randomly selected initial inpatient or outpatient consultation notes authored by the pediatric palliative care team at an academic, tertiary care children’s hospital. Inclusion required that patients were primarily cared for by general pediatricians, pediatric hospitalists, or pediatric intensivists, instead of subspecialists. Qualitative analysis by 5 team members utilizing consensus-based findings was used to develop themes. Descriptive statistics were used to describe variations in themes across age and disease course. RESULTS Common themes included thorough review of patient baseline functioning, current symptoms, assessment of family’s understanding of the prognosis of the patient, coordination of communication with other medical teams and outpatient health care services, consideration of caregiver resources and burdens, and offering a framework for decision-making. Variation in consult themes by age/disease course included more discussion of communication problems and symptom management when patients were at their baseline, but otherwise little variation was found. CONCLUSIONS Common themes covered in initial consultations correspond with documented unmet needs for chronically ill children. There was no significant variation in consultation themes by age/disease course, suggesting that generalists could broadly apply palliative care techniques to improve family-centered care.

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Communicating effectively with patients via e-mail is not intuitive but can be taught. It is feasible to introduce responses to a simulated e-mail case in a clinical clerkship as an assessment tool.

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Introduction: Adverse events are common in medical training and practice, which can lead to distress among providers. One method of coping with distress is debriefing, which has been shown to improve participants' ability to manage their grief and has been associated with lower rates of burnout. Methods: We designed this 2-hour workshop to provide senior residents with the knowledge and skills to lead debriefing sessions within their teams. In this curriculum, we have included a workshop facilitator's guide, didactic information reviewing the components of effective debriefing, a video of a sample debriefing, two videos demonstrating potential debriefing challenges, small-group practice cases, a debriefing pocket card resource, and pre-and postworkshop survey evaluations. Results: Twenty second-year pediatric and medicine-pediatric residents were included in the pilot study of this workshop. They reported an average of 2.2 (SD = 2.4) distressing events in the preceding month. None of the residents had received previous training in debriefing, and only 10% had previously led a debriefing session. Pre-and postintervention surveys demonstrated significant increases in resident comfort in and likelihood of leading a debriefing session, as well as in recognition of personal distress. Discussion: This workshop serves as one model to enhance training and education regarding debriefing in residency training programs. The issue of distress is not unique to residents, and although this training was initially designed for that population, it could easily be adapted to reach a broader audience of medical trainees and providers.

This study demonstrates one institution's experience with pediatric ESRD patients undergoing consultation with the pediatric palliative care service. More research is necessary in this population to better describe the best focus for palliative care teams.