Integrating Palliative Care into Interdisciplinary Rounds in an Adult ICU to Improve Early Goals of Care Conversations
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Authors
Schiefelbein, Hannah
Issue Date
2023-05-11
Volume
Issue
Type
Manuscript
Language
Keywords
Interdisciplinary Rounds , Goals of Care Conversations , Palliative Care , Critical Care , Advanced Care Directives
Alternative Title
Abstract
Purpose: Improve early goals of care conversations in an adult ICU by integrating the palliative care team into interdisciplinary rounds.
Background: Palliative care is often underutilized in the ICU setting. Conversations concerning goals of care are not typically done until the patient’s clinical condition demands this conversation to take place. Historically, ICUs have refrained from consulting palliative care unless they were considering end-of-life treatment. Consults are generally initiated late during a patient’s ICU stay. The term “goals of care” has been attributed to a narrow perspective and referred to only when resuscitation wishes are discussed. Delayed goals of care conversations can contribute to aggressive or unwanted interventions, patient/family dissatisfaction, and reduced quality of life or suffering.
Sample: This study was based on an adult ICU in a Midwestern Level II trauma hospital that serves a large rural community and included adults that were admitted or transferred to the ICU during an 8-week period.
Methods: Education was provided about the scope of practice for palliative care, the benefits of adding palliative care to daily interdisciplinary rounds, and the need to improve early goals of care conversations. A member of the Palliative Care team was invited to join the ICU’s daily interdisciplinary rounds. A “Smart Phrase” was developed to be used as documentation for early goals of care conversations. Data was collected pre-and post-implementation. A survey was then sent out to the Critical Care team and Palliative Care team to assess how this project was perceived.
Results: After project implementation, there was a decreased average LOS by 0.18 days, a 2% decrease in mortality, a 5% increase in formal consults placed (n=22, 16.9%), a 1% improvement in GOCC completed within the 24–48-hour timeframe, a decrease of 2.93 days until a formal consult was placed, and a 14.97% (n=20) increase in documented advanced care directives.
Conclusions and Implications for Practice: The aim was to improve further awareness of the scope of palliative care and reap the potential beneficial effects in an adult ICU setting. Improvements were made in the ICU length of stay, death rate, time to palliative care consults, and time to goals of care conversations. Shifting the ICU culture and perception of palliative care will also help reach the goal of providing quality care with an interdisciplinary, patient- and family-centered approach.
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Citation
Publisher
Creighton University
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Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University