Enhancing Palliative Care Integration in the Cardiac Surgical Intensive Care Unit: A Multidisciplinary Quality Improvement Project

Abstract

Objective

The rate of unmet palliative care (PC) needs is high in critical care areas, especially in the surgical patient population, where PC involvement is notoriously late in the patient’s clinical progression. This quality improvement project aimed to evaluate the ability of education, workflow delineation, and an evidence-based assessment tool to improve the integration of PC in a cardiac surgical intensive care unit (TICU).

Methods

This 12-week project utilized a pre-post intervention design to improve PC integration in a 16-bed TICU that serves cardiac, vascular and thoracic surgical, critical care patients. The intervention included education, workflow delineation, and an evidence-based frailty assessment (FA) implementation. PC consultation rate, advance care planning (ACP) note completion rate, and FA completion rate were measured to assess the feasibility and impact of this intervention on PC integration.

Results

A total of 313 patients were enrolled in this project. There was a 53.5% increase in palliative care consultation (P = 0.16), however the ACP note completion rate remained unchanged. The rate of FA completion rose from 0% to 30.4% (P < 0.0001).

Conclusion

FA is important in the setting of critical care, surgical patients. The outcomes of this project were similar to those of the existing literature, further revealing that ICUs are challenging care settings in which to connect patients with PC for the first time. Future studies on the effects of FA in the cardiac surgical patient population are warranted to find the most appropriate settings for assessment and associated interventions based on identifying a patient’s frailty.