Sage Journals: Discover world-class research

Abstract

Purpose:

Palliative care interventions have been shown to improve patient quality of life but the benefit may be less if interventions occur late in the patient’s disease process. The objective of this study was to evaluate whether an objective screening tool could improve the frequency and timeliness of palliative care consultation.

Methods:

Using a quasi-experimental design with 2 geographically separate medical intensive care units (MICUs), the control MICU continued existing consultation practice and the intervention MICU implemented a screening tool with each new admission. Any item checked on the screening tool triggered a palliative care consult within 24 hours of admission to the MICU.

Results:

A total of 223 MICU admissions were evaluated: 156 patients in the control group and 67 patients in the intervention group. More consults were generated in the intervention group (22.39%) compared to the control group (7.05%; P < .001). The median time to consultation was lower in the intervention group compared to the control group (1 day vs 2 days; P < .01).

Conclusion:

Implementing a simple, objective screening tool increased palliative consultation rates and decreased median time to palliative consultation in our institution’s MICU.

Keywords

critical care palliative care screening tool screening criteria consultation timing

Get full access to this article

View all access options for this article.

References

Casarett

Pickard

Bailey

. Do palliative consultations improve patient outcomes? J Am Geriatr Soc. 2008;56(4):593–599.

O’Mahony

McHenry

Blank

. Preliminary report of the integration of a palliative care team into an intensive care unit. Palliat Med. 2010;24(2):154–165.

Azoulay

Pochard

Chevret

. Impact of a family information leaflet on effectiveness of information provided to family members of intensive care unit patients: a multicenter, prospective, randomized, controlled trial. Am J Respir Crit Care Med. 2002;165(4):438–442.

Davidson

Powers

Hedayat

. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med. 2007;35(2):605–622.

Lautrette

Darmon

Megarbane

. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med. 2007;356(5):469–478.

Campbell

Guzman

. Impact of a proactive approach to improve end-of-life care in a medical ICU. Chest. 2003;123(1):266–271.

Lilly

De Meo

Sonna

. An intensive communication intervention for the critically ill. Am J Med. 2000;109(6):469–475.

Chanques

Jaber

Barbotte

. Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med. 2006;34(6):1691–1699.

Erdek

Pronovost

. Improving assessment and treatment of pain in the critically ill. Int J Qual Health Care. 2004;16(1):59–64.

10.

Campbell

Guzman

. A proactive approach to improve end-of-life care in a medical intensive care unit for patients with terminal dementia. Crit Care Med. 2004;32(9):1839–1843.

11.

Curtis

Treece

Nielsen

. Integrating palliative and critical care: evaluation of a quality-improvement intervention. Am J Respir Crit Care Med. 2008;178(3):269–275.

12.

Norton

Hogan

Holloway

Temkin-Greener

Buckley

Quill

. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med. 2007;35(6):1530–1535.

13.

Meier

. Increased access to palliative care and hospice services: opportunities to improve value in health care. Milbank Q. 2011;89(3):343–380.

14.

Weissman

Meier

. Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the center to advance palliative care. J Palliat Med. 2011;14(1):17–23.

15.

Hua

Blinderman

Wunsch

. Estimates of the need for palliative care consultation across united states intensive care units using a trigger-based model. Am J Respir Crit Care Med. 2014;189(4):428–436.

16.

Zalenski

Courage

Edelen

. Evaluation of screening criteria for palliative care consultation in the MICU: a multihospital analysis. BMJ. 2014;4(3):254–262.

17.

Angus

Barnato

Linde-Zwirble

. Use of intensive care at the end of life in the United States: an epidemiologic study. Crit Care Med. 2004;32(3):638–643.

18.

Billings

Keeley

Bauman

. Merging cultures: palliative care specialists in the medical intensive care unit. Crit Care Med. 2006;34(11 suppl):S388–S393.

19.

Dartmouth Institute for Health Policy and Clinical Practice. Percent of deaths associated with ICU admission. 2014; www.dartmouthatlas.org/data/table.aspx?IND=14. Accessed February 27, 2017.

20.

Society of Critical Care Medicine. Critical care statistics. 2010; www.sccm.org/Communications/Pages/CriticalCareStats.aspx. Accessed February 27, 2017.

21.

Gardiner

Gott

Ingleton

. Extent of palliative care need in the acute hospital setting: a survey of two acute hospitals in the UK. Palliat Med. 2013;27(1):76–83.

22.

Nelson

Campbell

Cortez

. Implementing ICU Screening Criteria for Unmet Palliative Care Needs: A Guide for ICU and Palliative Care Staff. New York, NY: Center to Advance Palliative Care; 2013.

Preliminary Analysis of a Modified Screening Tool to Increase the Frequency of Palliative Care Consults

Abstract

Purpose:

Methods:

Results:

Conclusion:

Keywords

Get full access to this article

References