Optimizing WOLST in the PICU Through the Use of a Huddle and Clinical Pathway

Introduction: Increasingly children are dying in the Pediatric Intensive Care Unit (PICU) as a result of withdrawal of life sustaining technology (WOLST). High quality end of life (EOL) care after WOLST may benefit from standardization. In addition, staff may feel better equipped to care for a child after WOLST if the team participates in a deliberate multidisciplinary huddle prior to WOLST. A needs assessment on EOL practices revealed lack of clear communication and documentation on the EOL care plan as the biggest barrier to quality EOL care. In an effort to optimize EOL care for children after WOLST, we developed a clinical pathway that relies on two WOLST huddles to prepare our teams for EOL care.


Methods: A multidisciplinary group from the PICU and the palliative care team met regularly to develop and review EOL interventions and outcomes. As a quality improvement project, we aimed to perform at least one multidisciplinary huddle in > 80% of deaths after WOLST in the PICU during 2024, as evidenced by documentation in the medical record, A secondary aim was to improve staff satisfaction and preparedness when caring for a child receiving WOLST.


Results: Baseline data was analyzed. In 2023, there were a total of 28 deaths in the PICU; 14/28 were as a result of WOLST. Of the 14 deaths after WOLST, there was no documentation of any communication regarding the EOL care plan. Our team underwent three PDSA cycles, with interventions including dissemination and education on the WOLST huddle and clinical pathway, identifying the charge nurse to initiate a huddle, and the development of a dot phrase. . Post intervention, data was re-analyzed. In 2024 there were 21 total PICU deaths; 12/21 of those deaths were a result of WOLST. 10/12 (83%) of deaths as a result of WOLST had at least one documented WOLST huddle. After the second PDSA cycle in February 2024, 10/10 (100%) of all deaths as a result of WOLST had at least one WOLST huddle documented in EPIC.


Conclusions: When a WOLST huddle was performed in our PICU, staff reported feeling more prepared, improved communication amongst the team, and improved quality of EOL care. Quantitative data from surveys of PICU staff to assess perceived effect of EOL interventions including the WOLST huddle are pending. Next steps include implementing WOLST huddles hospital wide.