The Problem
Patients, their families, and their providers have unmet palliative care needs in the ICU. Critically ill patients and their families have difficult end of life decisions to make, and often don’t know what to expect. However, there are many barriers to integrating palliative care efficiently in an ICU setting.
- Staffing limitations: Recent epidemiological studies report that up to 35% of all ICU admissions met at least one validated ‘trigger’ criteria for a palliative care consultation. Therefore, if an academic medical center implemented a palliative care trigger system in adult ICUs, over 1,500 additional annual palliative care consults could be expected—an infeasible task.
- Technological challenges: Using the electronic health records, it is difficult to identify patients who may benefit the most from a palliative care consult.
- Social challenges: There are concerns that ICU staff would be hesitant to fully support a trigger system unless they were able to approve the appropriateness of a palliative care consult.
Our Solution
We aimed to develop a set of measures which would trigger a daily report of patients who are candidates for palliative care consultations. We would then initiate a palliative care consult and collect patient needs, desires, and offer general education video to patients about the value of palliative care.
Impact
PCplanner (Palliative Care Planner) was successfully developed to screen for ICU patients meeting any of six palliative care consultation ‘triggers,’ to alert palliative care specialists to the consult request, and to allow families to self-report their palliative care needs. Application of triggers among 191 consecutive medical and surgical ICU patients over a two- week period revealed a high sensitivity (95%) compared to prospective manual chart review.
