Paediatric palliative care planning: a simulation based decision support

Paediatric palliative patients are children suffering fro incurable pathologies which cause them a lot of human, clinical, psychological, ethical and spiritual problems and require special assistance. Only in recent times they have been considered as specific patients needing qualified cares. The best organization of special cares, able to relief pain and to permit a bearable life, is based on integrated home assistance, including specific cares for the interested pathology, generic cares and psychological and social support, supplied by both a specialized hospital team and a territorial equip. Integrated home assistance may be interrupted by short admissions in a hospice, a dedicated facility apt to supply special cares and to assist also the family, and by short admissions in an acute hospital department, when necessary. Only if the above assistance methods cannot be adopted, simple home care, under control of a territorial equip, is effected. Here we built up a simulation model describing pediatric palliative patients movements among the interested health facilities, by considering interactions and competitions with ordinary patients for admissions in hospital departments. The model has been implemented in a personal computer by means of a specific simulation language, easily understandable also by non expert users. The model evidences how patients are assisted and how facilities are used; moreover it lets us remark improper hospital admissions due to fully occupied specifically facilities. Therefore it may be used as a decision support in the planning of a new assistance network or in the adjusting of an existing one. The model has been first applied to Veneto region in North-East Italy but can be easily adapted to describe other similar situations.