Implementation of a Palliative Care Screening Tool in the Medical ICU: A Quality Improvement Project
Loading...
Authors
Benz, Mikayla
Issue Date
2024-05-09
Type
Manuscript
Language
Keywords
Palliative Care , Triggers , Screening Tool , Palliative Barriers
Alternative Title
Abstract
Background: The World Health Organization reports that palliative care improves the quality of life of patients, their families, and their caregivers beyond any doubt (2020). Despite this growing need for palliative care, there is a persistent lack of qualifying patients getting referrals. Quality of life and care significantly impact patient satisfaction rates, which hospitals continually track. Early palliative interventions also have many fiscal benefits, resulting in a positive fiscal impact for hospitals through decreased length of stay, resource utilization, and hospital readmissions.
Purpose: This quality improvement project aimed to enhance specialty palliative care utilization in a 16-bed medical intensive care unit (MICU) at a level I trauma center through the implementation of a nurse-led palliative care screening.
Methods: An established palliative care screening tool from the Center to Advanced Palliative Care was recreated as a Microsoft Forms survey completed by MICU nurses daily during the intervention period to determine if their patients met the recommended eligibility criteria for a palliative care consultation. If a patient’s screening indicated that they were appropriate for a palliative care consultation and palliative care was not already involved in the case, the nurse would report the screening tool results to the attending during multidisciplinary rounds. If the physician feels that a palliative care consultation is appropriate, then the physician places a consultation order. Regardless of the screening tool results, the physician retained their independence in determining whether to place a palliative care consultation.
Results: Palliative care consultations increased by 52% during the ten-week implementation period compared to the ten-week pre-intervention baseline. Palliative providers reported receiving appropriate consults earlier in a patient's hospital stay, allowing time to build rapport with the patient. Nurses reported increased awareness of palliative care’s role on the treatment team and a better understanding of palliative qualifying factors. Despite the positive outcomes, overall adherence to the palliative care screening tool was poor, with screening forms submitted by only 11% of the eligible ICU population during the implementation period.
Conclusion: Educating MICU nurses about a palliative care screening tool and requiring discussion of palliative care eligibility during daily multidisciplinary rounds positively impacted palliative care utilization in the MICU at this facility despite poor adherence to a screening form submission by the nursing staff. A screening tool should be incorporated into the electronic medical record if a facility desires documentation of palliative care eligibility criteria.
Description
Citation
Publisher
Creighton University
License
Copyright is retained by the Author. A non-exclusive distribution right is granted to Creighton University