J E Nelson1, C M Mulkerin, L L Adams, P J Pronovost. 1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA. judith.nelson@mountsinai.org
Abstract
OBJECTIVE: To develop a practical set of measures for routine monitoring, performance feedback, and improvement in the quality of palliative care in the intensive care unit (ICU). DESIGN: Use of an interdisciplinary iterative process to create a prototype "bundle" of indicators within previously established domains of ICU palliative care quality; operationalization of indicators as specified measures; and pilot implementation to evaluate feasibility and baseline ICU performance. SETTING: The national Transformation of the Intensive Care Unit program developed in the United States by VHA Inc. PATIENTS: Critically ill patients in ICUs for 1, > 3, and > 5 days. MEASUREMENTS AND MAIN RESULTS: Palliative care processes including identification of patient preferences and decision making surrogates, communication between clinicians and patients/families, social and spiritual support, and pain assessment and management, as documented in medical records. Application is triggered by specified lengths of ICU stay. Pilot testing in 19 ICUs (review of > 100 patients' records) documented feasibility, while revealing opportunities for quality improvement in clinician-patient/family communication and other key components of ICU palliative care. CONCLUSIONS: The new bundle of measures is a prototype for routine measurement of the quality of palliative care in the ICU. Further investigation is needed to confirm associations between measured processes and outcomes of importance to patients and families, as well as other aspects of validity.
OBJECTIVE: To develop a practical set of measures for routine monitoring, performance feedback, and improvement in the quality of palliative care in the intensive care unit (ICU). DESIGN: Use of an interdisciplinary iterative process to create a prototype "bundle" of indicators within previously established domains of ICU palliative care quality; operationalization of indicators as specified measures; and pilot implementation to evaluate feasibility and baseline ICU performance. SETTING: The national Transformation of the Intensive Care Unit program developed in the United States by VHA Inc. PATIENTS: Critically illpatients in ICUs for 1, > 3, and > 5 days. MEASUREMENTS AND MAIN RESULTS: Palliative care processes including identification of patient preferences and decision making surrogates, communication between clinicians and patients/families, social and spiritual support, and pain assessment and management, as documented in medical records. Application is triggered by specified lengths of ICU stay. Pilot testing in 19 ICUs (review of > 100 patients' records) documented feasibility, while revealing opportunities for quality improvement in clinician-patient/family communication and other key components of ICU palliative care. CONCLUSIONS: The new bundle of measures is a prototype for routine measurement of the quality of palliative care in the ICU. Further investigation is needed to confirm associations between measured processes and outcomes of importance to patients and families, as well as other aspects of validity.
Authors: J E Nelson; D E Meier; E J Oei; D M Nierman; R S Senzel; P L Manfredi; S M Davis; R S Morrison Journal: Crit Care Med Date: 2001-02 Impact factor: 7.598
Authors: Judith E Nelson; Derek C Angus; Lisa A Weissfeld; Kathleen A Puntillo; Marion Danis; David Deal; Mitchell M Levy; Deborah J Cook Journal: Crit Care Med Date: 2006-10 Impact factor: 7.598
Authors: J M Teno; E Fisher; M B Hamel; A W Wu; D J Murphy; N S Wenger; J Lynn; F E Harrell Journal: J Am Geriatr Soc Date: 2000-05 Impact factor: 5.562
Authors: E Azoulay; S Chevret; G Leleu; F Pochard; M Barboteu; C Adrie; P Canoui; J R Le Gall; B Schlemmer Journal: Crit Care Med Date: 2000-08 Impact factor: 7.598
Authors: Lawrence A Ho; Ruth A Engelberg; J Randall Curtis; Judith Nelson; John Luce; Daniel E Ray; Mitchell M Levy Journal: Crit Care Med Date: 2011-05 Impact factor: 7.598
Authors: Judith E Nelson; Kathleen A Puntillo; Peter J Pronovost; Amy S Walker; Jennifer L McAdam; Debra Ilaoa; Joan Penrod Journal: Crit Care Med Date: 2010-03 Impact factor: 7.598
Authors: Judith E Nelson; Therese B Cortez; J Randall Curtis; Dana R Lustbader; Anne C Mosenthal; Colleen Mulkerin; Daniel E Ray; Rick Bassett; Renee D Boss; Karen J Brasel; Margaret L Campbell; David E Weissman; Kathleen A Puntillo Journal: J Hosp Palliat Nurs Date: 2011-03 Impact factor: 1.918
Authors: Michael E Wilson; Lori M Rhudy; Beth A Ballinger; Ann N Tescher; Brian W Pickering; Ognjen Gajic Journal: Intensive Care Med Date: 2013-04-05 Impact factor: 17.440
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