Eluned Mun1, Clementina Ceria-Ulep2, Lillian Umbarger3, Craig Nakatsuka4. 1. Retired Intensive Care Nurse and a current Nurse Practitioner at the Rehabilitation Hospital of the Pacific in Honolulu, HI. emun@rehabhospital.org. 2. Professor and Department Chair in the School of Nursing and Dental Hygiene at the University of Hawaii at Manoa in Honolulu. clem@hawaii.edu. 3. Intensivist and Pulmonologist at the Moanalua Medical Center in Honolulu, HI. lillian.a.umbarger@kp.org. 4. Palliative Care and Internal Medicine Physician at the Moanalua Medical Center in Honolulu, HI. craig.nakatsuka@kp.org.
Abstract
CONTEXT: Is a decrease in length of stay (LOS) in the intensive care unit (ICU) and hospital possible with the implementation of a structured, palliative care, quality-improvement program in the ICU? OBJECTIVE: Incorporate palliative care into the routine ICU workflow to increase the numbers of palliative care consultations, improve end-of-life care in the ICU, and demonstrate an impact on ICU and/or hospital LOS. DESIGN: A program was developed that followed recommendations from the Center to Advance Palliative Care's Improving Palliative Care in the ICU project. This program included selecting trigger criteria and a care model, forming guidelines, and developing evaluation criteria. The early identification of multiple measures led to proactive meetings with ICU patients' families and/or palliative care consultations. MAIN OUTCOME MEASURES: Early identification of advance directives, code status, goals of care, and ICU LOS and hospital LOS. RESULTS: A comparison between pre- and postintervention data showed positive trends in measured outcomes, including increased early identification of advance directives, code status, and goals of care along with a decrease in ICU LOS and hospital LOS. In addition, the number of ICU family meetings and palliative care consultations increased. CONCLUSION: It was concluded that providing palliative care in the ICU is feasible and may decrease both ICU LOS and overall hospital LOS.
CONTEXT: Is a decrease in length of stay (LOS) in the intensive care unit (ICU) and hospital possible with the implementation of a structured, palliative care, quality-improvement program in the ICU? OBJECTIVE: Incorporate palliative care into the routine ICU workflow to increase the numbers of palliative care consultations, improve end-of-life care in the ICU, and demonstrate an impact on ICU and/or hospital LOS. DESIGN: A program was developed that followed recommendations from the Center to Advance Palliative Care's Improving Palliative Care in the ICU project. This program included selecting trigger criteria and a care model, forming guidelines, and developing evaluation criteria. The early identification of multiple measures led to proactive meetings with ICU patients' families and/or palliative care consultations. MAIN OUTCOME MEASURES: Early identification of advance directives, code status, goals of care, and ICU LOS and hospital LOS. RESULTS: A comparison between pre- and postintervention data showed positive trends in measured outcomes, including increased early identification of advance directives, code status, and goals of care along with a decrease in ICU LOS and hospital LOS. In addition, the number of ICU family meetings and palliative care consultations increased. CONCLUSION: It was concluded that providing palliative care in the ICU is feasible and may decrease both ICU LOS and overall hospital LOS.
Authors: Richard A Mularski; J Randall Curtis; J Andrew Billings; Robert Burt; Ira Byock; Cathy Fuhrman; Anne C Mosenthal; Justine Medina; Daniel E Ray; Gordon D Rubenfeld; Lawrence J Schneiderman; Patsy D Treece; Robert D Truog; Mitchell M Levy Journal: Crit Care Med Date: 2006-11 Impact factor: 7.598
Authors: Judith E Nelson; Rick Bassett; Renee D Boss; Karen J Brasel; Margaret L Campbell; Therese B Cortez; J Randall Curtis; Dana R Lustbader; Colleen Mulkerin; Kathleen A Puntillo; Daniel E Ray; David E Weissman Journal: Crit Care Med Date: 2010-09 Impact factor: 7.598
Authors: Peter M Reardon; Shannon M Fernando; Sasha Van Katwyk; Kednapa Thavorn; Daniel Kobewka; Peter Tanuseputro; Erin Rosenberg; Cynthia Wan; Brandi Vanderspank-Wright; Dalibor Kubelik; Rose Anne Devlin; Christopher Klinger; Kwadwo Kyeremanteng Journal: Crit Care Res Pract Date: 2018-09-02