Komal Patel Murali1, Laura D Fonseca2, Craig D Blinderman3, Douglas B White4, May Hua5. 1. School of Nursing, Columbia University, 560 West 168th Street, New York, NY 10032, United States of America. Electronic address: krp2130@cumc.columbia.edu. 2. Department of Anesthesiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY 10032, United States of America. Electronic address: lf2560@cumc.columbia.edu. 3. Department of Medicine, Adult Palliative Medicine Service, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, United States of America. Electronic address: cdb21@cumc.columbia.edu. 4. Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, United States of America. Electronic address: douglas.white@pitt.edu. 5. Department of Anesthesiology, Columbia University Irving Medical Center, 630 West 168th Street, New York, NY 10032, United States of America; Mailman School of Public Health, Columbia University, Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, United States of America. Electronic address: mh2633@cumc.columbia.edu.
Abstract
PURPOSE: To understand clinicians' views regarding use of clinical criteria, or triggers, for specialist palliative care consultation in the ICU. MATERIALS AND METHODS: Secondary analysis of a qualitative study that explored factors associated with adoption of specialist palliative care in the ICU. Semi-structured interviews with 36 ICU and palliative care clinicians included questions related to triggers for specialist palliative care. We performed a thematic analysis to identify participants' views on use of triggers, including appropriateness of cases for specialists and issues surrounding trigger implementation. RESULTS: We identified five major themes: 1) Appropriate triggers for specialist palliative care, 2) Issues leading to clinician ambivalence for triggers, 3) Prospective buy-in of stakeholders, 4) Workflow considerations in deploying a trigger system, and 5) Role of ICU clinicians in approving specialist palliative care consults. Appropriate triggers included end-of-life care, chronic critical illness, frequent ICU admissions, and patient/family support. Most clinicians had concerns about "trigger overload" and ICU clinicians wanted to be broadly involved in implementation efforts. CONCLUSIONS: ICU and palliative care clinicians identified important issues to consider when implementing triggers for specialist palliative care consultation. Future research is needed to longitudinally examine the most appropriate triggers and best practices for trigger implementation.
PURPOSE: To understand clinicians' views regarding use of clinical criteria, or triggers, for specialist palliative care consultation in the ICU. MATERIALS AND METHODS: Secondary analysis of a qualitative study that explored factors associated with adoption of specialist palliative care in the ICU. Semi-structured interviews with 36 ICU and palliative care clinicians included questions related to triggers for specialist palliative care. We performed a thematic analysis to identify participants' views on use of triggers, including appropriateness of cases for specialists and issues surrounding trigger implementation. RESULTS: We identified five major themes: 1) Appropriate triggers for specialist palliative care, 2) Issues leading to clinician ambivalence for triggers, 3) Prospective buy-in of stakeholders, 4) Workflow considerations in deploying a trigger system, and 5) Role of ICU clinicians in approving specialist palliative care consults. Appropriate triggers included end-of-life care, chronic critical illness, frequent ICU admissions, and patient/family support. Most clinicians had concerns about "trigger overload" and ICU clinicians wanted to be broadly involved in implementation efforts. CONCLUSIONS: ICU and palliative care clinicians identified important issues to consider when implementing triggers for specialist palliative care consultation. Future research is needed to longitudinally examine the most appropriate triggers and best practices for trigger implementation.
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